FASTag Application Form - ICICI Bank
Kindly provide the below documents if your ETC Tag balance or aggregate toll transactional value exceed Rs.10,000 at any given point in time during the month.*CorporatePublic Ltd/Private Ltd/PartnershipProprietorship*Certificate of tration certificate of thePAN Card NumberPAN Card of*PAN Card of the corporateNumber*Shop Act or other FirmPAN CardProof*GST Registration CertificatePhoto ID of signing authorityGST Registration CertificateList of Directors with addresses/Name and addresses of Partners*IndividualPlease submit ID proof and Address proof documents from the following list of valid documentsPassportVoter ID Card(for individual customer transactions not exceeding the aggregate sum of Rs.10,000 per month)*Proof of Identity Document Number:PAYMENT DETAILSPayment Mode:ChequeCash *NEFT(*Payment by cash is acceptableONLY at select POS locations)Amount:Others (Please Specify)Cheque Details:Cheque No.:Cheque Date:UTR No.:(For Official use only)ANNEXURECharges applicable on ICICI Bank Tag:PARTICULARSAMOUNT (INR)Tag Joining FeePlease note:1. Tag joining fee is inclusive of GST.2. Convenience fee will be applicable for online recharge which is charged by payment gateway service provider3. Charges mentioned above are subject to change. Please visitwww.icicibank.com for the latest changes One – time Tag Deposit amount (Refundable):Tag ClassDescriptionTag ColorTag DepositThreshold Amount4Car / Jeep / VanViolet2002004TATA Ace and Similar mini Light Commercial VehicleViolet2001005Light Commercial Vehicle/Mini BusOrange3001406Bus 3- AxleYellow4003006Truck 3 – AxleYellow5003007Bus 2 – Axle /Truck 2- AxleGreen40030012Tractor / Tractor with trailer / Truck 4 / 5 / 6 AxlePink50030015Truck 7 – Axle and aboveBlue50030016Earth Moving / Heavy Construction MachineryBlack500300Note: The above mentioned Tag deposit rates would be applicable depending on your vehicle class and would be refunded to you at the time of ICICI Bank FASTag account closure. For more information about your account andapplicable rates, please visit www.icicibank.com/fastag
FOR OFFICIAL USE ONLY:ICICI Bank FASTag Customer Id:Application Reference Number:Transaction Date:DDTotal Amount Received:MMYYYY I confirm the form has been signed by the applicant in my presence.I also confirm the documents provided by the applicant have been verified with the originals.All documents scrutinized and found in order by official at Agent locationAll documents completedand submitted on:DDMMYYYYSignature of the POS Agent Official/Bank OfficialPOS VSTS No.:Bank Official Name and Employee Id:VEHICLE DETAILS*License Plate Number/Engine Number/Chasis Number*ICICIBankfundedY/N*Vehicle Type /Vehicle Class* Tag Deposit*Mobile No.AmountPlaza Name for monthly passTotal ( ):Total no. of tags appliedfor:Primary Bank for recharging the ETC Tags:( Use annexure if more than 8)Annexure Used:YesNoAnnexure Number:(If Annexure is used for listing vehicles)CONSUMER RECEIPTCustomer Name:Total Amount uploaded onICICI Bank Tag:Point of Sale (POS) kiosk name :Total amount received from the customer:Location:
Date:DDEmployee name andMMYYYY ICICI Bank FASTag is issued by ICICI Bank Ltd.*Terms and conditions apply Point of Sale (POS) collect fee(s) from customers on behalfof ICICI Bank Ltd.Stamp of POS agency with date:Customer Care: 1800 210 0104
DECLARATIONI declare, confirm, and agree that:1. I have read,understood and hereby agree to the terms and conditions as applicable to ICICI Bank FASTag as set forth on the website – www.icicibank.com/fastag which may beamended from time to time. I understand that access to any changes/updation in terms and conditions applicable to this account/relationship would be available on the website onlyand I shall agree to abide by the same.2. All the particulars and information given in this application form (and all documents referred or provided therewith) are true, correct, complete and up-to-date in all respects and I havenot withheld any information. I agree and undertake to provide any further information that ICICI Bank/its Group Companies may require from time to time3. I understand that ICICI Bank Limited (“ICICI Bank”) reserves the right to reject my application without providing any reason. I agree and understand that ICICI Bank/its GroupCompanies reserve the right to retain the application forms, and the documents provided herewith and will not return the same to me.4. I authorize ICICI Bank/its Group Companies or there agents to make references and enquires which ICICI Bank/its Group Companies consider necessary in respect of or in relation toinformation in this application.5. To inform ICICI Bank & its Group Companies immediately regarding any change in any of the information provided by me in this application form and to provide any further informationthat ICICI Bank & its Group Companies may require from time to time.6. I authorize ICICI Bank/its Group Companies to exchange, share or part with all the information, data or documents relating to my application with other ICICI Group Companies/ Banks/Financial Instruction /Credit bureaus/Agencies/Statutory Bodies or any other persons as ICICI Bank/its Group Companies may deem necessary or appropriate or as may be requiredfor use or processing of the said information/data by such person or ICICI Bank/its group companies and shall not hold ICICI Bank/its Group Companies liable for the use/sharing ofthis information by either ICICI Bank or such third parties.7. I authorize ICICI Bank unconditionally and irrevocably to debit the relevant fees and charges applicable to the ICICI Bank Tag (as mentioned in the “Terms and Conditions”, “Scheduleof Charges” and “Product Leaflet" ) from the funds available in my ICICI Bank Tag Account.8. I declare that the information I have provided is accurate and complete to the best of my knowledge. I authorize ICICI Bank & its representatives to call or SMS me with reference tomy Tag and ancillary product applications. This consent will override any registration for DNC/NDNC which you may have registered.9. I authorize ICICI Bank to unconditionally use my Aadhaar details as provided with my ICICI Bank Savings/Current Account or any other product I may have availed from ICICI Bank.10. I have understood the offer and details of the Value Added Service provided by ICICI Bank. I am willingly subscribing to the VAS offering and promise to pay the sum payable foravailing the service.11. I hereby give my consent to use/exchange or share my Aadhaar number, Aadhaar information for registration of client information with Exchange, KRA, CERSAI and with any otherregulatory agency of ICICI Bank which it deems fit or as per requirements of law .Please ensure that prior to submitting the application form you have received the ICICI Bank FASTag product leaflet and have understood the: Schedule of Rates and Charges Refer www.icicibank.com for detailed Terms and ConditionsSignature of the authorized signatory / Individual CustomerHow to recharge your ICICI Bank FASTag account ?ICICI Bank FASTag can be recharged through modes like- internet banking, NEFT/RTGS, UPI, credit card, debit card, cheque, cash etc.For online recharges: Visit www.icicibank.com/fastag with your username and password Go to Payments Recharge account Select Tag/CUG wallet recharge as applicable and choose the payment made as per your convenience Choose from one of the following options available For more details, Terms and Conditions, kindly visit www .icicibank.com/fastagAvailable optionsFunds upload timeConvenience fee#ICICI Bank CIB and RIBReal timeNilUPIReal timeNilDebit cardReal time0.2%-0.85% of the transaction value*Credit cardReal time1.8% of transaction value*Internet bankingReal time1%- 1.65% of the transaction value*NEFTAs per NEFT cycle CUG wallet recharge: Free or NEFT/RTGS charged as levied by source bank Tag Wallet Recharge: Rs.15 per transaction for tag level recharge
ChequeICICI Bank - T plus oneNilOther Bank - T plus four(T is the time or the date when thetransaction is initiated.)Plus,taxes as per the prevailing application rates.# Convenience fee is levied by the payment gateway for the services provided and not by ICICI Bank. The fee is levied against the cost of transaction and not for revenue inthe FASTag program.*Convenience fee may change basis the payment gateway selected and/or change in commercials between ICICI Bank and the payment gateway .Payment Gateway ModeBilldeskRazorpayDebit card (Visa/Master Card)Below and equal to INR.2000-0.36% &above INR.2000-0.86%Below and equal to INR.2000-0.40% & above INR.2000-0.80%Credit card0.90%0.75%American Express Credit Card & Diners CreditCard0.90%2.60%Internet bankingFor HDFC 1.2% and other Bank-1.1%HDFC-INR 11. Yes/Axis-INR 10.5. ICICI/Kotak/SCB-INR 5.5. Rest-INR 7UPI0.03%NILFor offline recharge modes Recharge through cash/cheque is available in selected point of sales (POS) locations. For more details, please contact the Customer Care on 1800 210 0104 or visitwww.icicibank.com/fastag
this information by either ICICI Bank or such third parties. 7. I authorize ICICI Bank unconditionally and irrevocably to debit the relevant fees and charges applicable to the ICICI Bank Tag (as mentioned in the “Terms and Conditions”, “Schedule of Charges” and “Product Leaflet" ) from the funds available in my ICI
Titanium Credit Card / ICICI Bank HPCL Coral Credit Card 199 Nil 199 Nil 50,000* ICICI Bank Platinum Chip Credit Card Nil Nil Nil Nil Nil Manchester United Signature Credit Card by ICICI Bank 2,499 Nil 2,499 100 2,50,000* Manchester United Platinum Credit Card by ICICI Bank 499 Nil 499 100 1,25,000* ICICI Bank Unifare Credit Card
Tag class is as per the vehicle class defined under NETC program and tolling categories of the toll plaza. There are 7 Tag classes as per tolling class at the toll plaza of National Highway. These classes are written on FASTag. Issuer can identify the Fastag with classes written on the tag. Toll plaza
Bhuj Mercantile Co-op. Bank RTGS Form . 12 BOB RTGS Form . 13 BOI RTGS Form . 14 CANARA BANK RTGS Form. 15 CBI RTGS Form . Federal Bank Second Page RTGS From . 20 HDFC RTGS Form. 21 HSBC RTGS Form. 22 ICICI Bank RTGS Form. 23 IDBI Bank RTGS Form. 24 IDFC First Bank RTGS Form. 25 Indian Overseas Bank RTGS Form . 26 INDUSLND Bank RTGS Form . 27 .
Credit Card Nil 7,000 7,000 Nil NA ICICI Bank British Airways Classic Credit Card Nil 3,500 3,500 Nil NA ICICI Bank Rubyx Credit Card 3,000 Nil 2,000 Nil 3,00,000* ICICI Bank Rubyx Visa Credit Card 3,000 Nil 2,000 Nil 3,00,000* InterMiles ICICIBank Sapphiro
The board of directors of ICICI Bank, consisting of 18 members at August 31, 2003, is responsible for the management of ICICI Bank's business. The organizational documents of ICICI Bank provide for a minimum of three directors and a maximum of 21 directors, excluding the government director and the debenture director (defined below), if any.
M/s G.M. Kapadia & Co., Chartered Accountants Bankers HDFC Bank Ltd. (Primary Banker) Axis Bank Ltd. Bank of Baroda Bandhan Bank Ltd. Citibank N.A. CSB Bank Ltd. DCB Bank Ltd. Deutsche Bank ESAF Small Finance Bank ICICI Bank Ltd. IDFC Bank Ltd. Indian Bank RBL Bank Ltd. Saraswat Co-op Bank Ltd. State Bank of India Suryoday Small Finance Bank Ltd.
Application for State Bank of India FASTag (Legal Entity) For Office use only All fields marked with * are mandatory, Fill form in English in Block Letters, Date format should be dd/mm/yyyy,
BAR and BAN List – Topeka Housing Authority – March 8, 2021 A. Abbey, Shanetta Allen, Sherri A. Ackward, Antonio D. Alejos, Evan Ackward, Word D. Jr. Adams .
