Fill in a Valid Icici Pay Direct Card Template

The ICICI Pay Direct Card form is an application document designed for individuals seeking to obtain a Pay Direct Card or Meal Card from ICICI Bank. This form requires accurate personal details, identity proof, and declarations regarding the applicant's employment and financial history. For a seamless experience in submitting your application, please fill out the form by clicking the button below.

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The ICICI Pay Direct Card Application Form serves as a comprehensive document designed to facilitate the issuance of Pay Direct and Meal Cards through ICICI Bank. This form is fundamental for individuals looking to benefit from the card services offered. Notably, it comprises several key fields that applicants must complete, ensuring that essential personal information and professional details are accurately submitted. The form requests various mandatory data points such as the applicant's name, date of birth, contact information, and employer details. Identity verification is a crucial part of the application process; hence, applicants must provide a verified copy of an acceptable identity proof, which may include a passport, voter ID, or driving license, among others. The form also includes sections dedicated to the declaration of truthfulness regarding the provided information, as well as consent for future communications from ICICI Bank. Additionally, a one-time fee for the card must be submitted with the application, confirming the applicant's commitment to the terms and conditions outlined by the bank. As such, understanding this form is vital for anyone seeking to access the benefits of the ICICI Pay Direct Card.

Icici Pay Direct Card Example

Ref No:

Card No:

Branch Code:

DMA Code:

Company PPA Code:

Pricing Code:

Application No. :

Version 3,September 2004.

Pay Direct Card / Meal Card Application Form

FIELDS WITH

ARE MANDATORY

Branch :

Date :

I / We hereby apply for Pay Direct Card / Meal Card with your bank.

YYYY

P E R S O N A L D E T A I L S

*New Applicant:

Mr. / Ms. / Dr.

First Name

Middle Name

Last Name

*Date of Birth :

YYYY

*Flat No./Society Name :

*Road No./Name :

*Nearest Landmark :

*City :

*Tel. No. :

STD Code

*Mother’s Maiden Name :

E-mail ID :

*Permanent Address :

C O M M U N I C A T I O N A D D R E S S

(R)

(O)

Mobile

(This information may be used to verify your identity when you want your card account details over phone.)

*City :

*State :

*PIN :

STD code :

Tel. :

IDENTITY PROOF

( Verified true copy of any one of the following valid documents duly verified with the originals by a bank official):

Passport

Original Letter of introduction from existing bank

Driving Licence

Voters identity cards

Employee identity cards

PAN Card

Photo Credit Card along with the current billing cycle (latest) statement

Arms licence issued by state/ Central Government of India authority with photograph of applicant

Pension book issued by Government of India with photograph of applicant containing name, address and validity period.

Freedom fighters pass issued by home ministry of government of India with photograph of applicant

For married women, proof of identity with her maiden name, if supported with a verified true copy of marriage certificate are acceptable as valid identity proof.

* PAN/ GIR No. Of First Applicant :

FROM 60 / 61 ( TO BE FILED BY THOSE WHO DO NOT HAVE EITHER PAN OR GIR )

Are you a Tax Assessee

Yes

If yes, (a) Details of ward/ Circle/Range ware the last return of income was filed

(b) Reason for not having PAN/GIR No. :

*(Copy of Pancard Mandatory )


I		do hereby declare that what is stated is true to the best of my knowledge and belief.
Verified at	this the		day of	200

Signature of the declarant

A B O U T Y O U R W O R K

*Name of the Company :

*Department :

*Office Address :

* City :

* STD code :

Tel. : 1

Address & Signature verified as per the company records

Name of Authorised Signatory :

Tel. : 2

PIN :

Extn. No . :

Company Official’s Signature Verified

Date :

Signature with Seal

by the Bank Officer (AM & Above/SE/BDE)

YYYY

S I G N A T U R E S A N D P H O T O G R A P H S

Signature of Bank official in whose presence signed

Date :

DDMMYYYY

Applicant’s

Photo

Please affix a recent photograph. Please sign in black ink within the box

Signature of applicant

C A R D C H A R G E S

Card Charges for Rs. 200/- one time fees to be paid in Demand Draft Drawn in favour of “ICICI Bank Limited” and Attach with the Application Form

D E C L A R A T I O N

I have understood and here by agree to the Terms and Conditions as applicable to my Card set forth on the website www.icicibank.com. I understand that Access to any changes/Updating in terms and conditions applicable to this relationship would be available on the website only. I do hereby declare that information furnished in this form is true to the best of my knowledge and belief.

I declare, confirm, agree:

•That 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 have not withheld any information. I understand that certain particulars given by me are required by the operational guidelines governing banking companies. I agree and undertake to provide and further information that ICICI Bank Ltd./its Group Companies may require.

•That I have had no insolvency proceedings initiated against me nor have I ever been adjudicated insolvent.

•That I have read the application form and brochures and am/are aware of all the terms/conditions of availing finance or service or products from ICICI Bank an its group companies and/or its and ICICI Bank.

•I agree and understand that ICICI Bank limited / Group Companies reserve the right to reject any application without providing any reason. I agree and understand that ICICI Bank Ltd. /Its Group Companies reserve the right to retain the application forms, and the documents provide therewith, including photographs and will not return the same to me.

•I have also read and understood Terms and conditions under which the scheme is offered to my organisation and its employees.

•I agree that my employer has full right to revers an instruction given by them for any amount within a period of three working days and I will not dispute or hold the bank responsible for any such debits on the Card.

I understand that it is my responsibility to inform ICICI Bank immediately on termination of my employment with my current employer whereupon I will cease to enjoy any or all benefits under this scheme.

ICICI Bank/its Group Companies or there agents to make references and enquires which ICICI Bank Ltd./ Its Group Companies consider necessary in respect of or relation to information in this application. To inform ICICI Bank & its Group Companies regarding change in my residence / employment and to provide any further information that ICICI Bank & its Group Companies may require from time to time. ICICI Bank Ltd. / its Group Companies to exchange share or part with all the information data or documents relating to my application to other ICICI Group Companies/ Bank/ Financial Instruction / Credit bureaus / Agencies Statutory Bodies such other persons as ICICI Bank Ltd. /Its Group Companies may deem necessary or appropriated as may be required for use or processing of the said information/data by such person or fumishing of the processed information/data/products thereof to other Banks/Financial Institutions / Credit provider /users registered with such persons and shall not hold ICICI Bank Ltd./its Group Companies liable for use of this information

I agree and understand that I have to complete further applications for specific liability products services from ICICI Bank Ltd./ Its Group Companies as prescribed from time to time and that such further application shall be regarded as an integral part of this application and vice versa and that unless otherwise disclosed in such further forms are prescribed the particulars and information set forth herein as well as the documents referred or provide herewith are true, correct, complete and up-to-date in all respect. I agree and understand that such further application will require incorporation of the application form number, and/or such details as ICICI Bank may prescribe, to facilitate data management.

I authorise ICICI Bank Ltd. to issue an ICICI Bank Pay Direct Card / Meal Card / Reimbursement Card to me. I acknowledge that the issue and usage of the Pay Direct Card / Meal Card / Reimbursement Card is governed by the terms and conditions as in force from time to time and agree to be bound by the same. I accept that the terms and condition of Pay Direct Card / Meal Card / Reimbursement Card are liable to be amended by ICICI Bank Ltd. from time to time. I further unconditionally and irrevocably authorise ICICI Bank Ltd. To debit my Account annually with an amount equivalent to the fee and charges for use of the card. I hereby confirm that this account will be operated singly.

The Applicant/s has/have no objection to ICICI Bank Limited, its group companies, agents/representatives to provide me/us information on various products, offers and services provided by ICICI Bank Limited/its group companies through any mode (including without limitation through telephone calls/SMSs/emails) and authorise ICICI Bank Limited, its group companies, agents/representatives for the above purpose.

(Please tick Yes or No, as acceptable to the Applicant/s) : Y:

OR N:

Signature of Applicant

KYC CERTIFICATION FOR NEW CUSTOMERS

*Name of the Bank Official / SE / BDE

Employee No.

* Date :

YYYY	Signature of Bank Official / SE / BDE and Branch stamp with Branch Code

FOR ICICI BANK USE ONLY

Charged Kit.:

Yes

Documentation Completed and form submitted on:Date :

Account Opening Form scrutinized and found in Date :

order Channel Registration Approved by :

Checked by DVU Official at RPC

Date :

YYYY

If rejected, reason:

Form Scanned on :

Date :

YYYY

Scanned image transfered on : Date :

YYYY

SE / BDE / BM / BOM Signature

Signature

Please affix Acknowledgement for WELCOME KIT received from Account holder

Click for Icici Pay Direct Card File

File Breakdown

Fact Name	Description
Document Version	This application form is Version 3, dated September 2004.
Mandatory Fields	Certain fields, marked with asterisks (*), are mandatory to complete the application.
Application Fee	A one-time fee of Rs. 200 must be paid via Demand Draft made out to “ICICI Bank Limited” and attached to the application.
Identity Verification	A verified true copy of one valid identity document is required for application approval.

Guide to Using Icici Pay Direct Card

To successfully complete the ICICI Pay Direct Card form, you will need to gather your personal information, identification documents, and employment details. Careful attention to the required fields is essential, and submission will also involve a payment for card charges. Follow the steps outlined below to fill out the form accurately.

Enter the Reference Number and card details such as Card Number and Branch Code.
Fill in the Date in the format DD MM YYYY.
Indicate if you are a New Applicant by selecting either Mr./Ms./Dr. followed by your First Name, Middle Name, and Last Name.
Provide your Date of Birth in the format DD MM YYYY.
Complete your address details including Flat No./Society Name, Road No./Name, and Nearest Landmark.
Fill in your City, Telephone Number, and STD Code.
Include your Mother’s Maiden Name and Email ID.
List your Permanent Address.
Select your Communication Address, either Residential (R) or Office (O).
Enter your Mobile number, City, State, and PIN code, as well as the STD Code if applicable.
Provide the details of your identity proof. Choose one valid document from the list and ensure it is verified by a bank official.
Enter your PAN/GIR Number or complete the section if you don't have either.
Respond to the Tax Assessee question by selecting Yes or No. If yes, provide the details of where your last income return was filed.
Sign and date the declaration indicating that the information provided is accurate.
Fill in your Company Name, Department, Office Address, and Contact Details.
Have your address and signature verified by a company official and include their details.
Attach your photograph in the designated area and sign it in black ink within the box provided.
Submit payment for the card charges of Rs. 200/- through a Demand Draft drawn in favor of “ICICI Bank Limited” and attach with your application form.
Read and acknowledge agreement to the Terms and Conditions outlined. Sign the declaration at the end of the form.
Ensure all required documents are attached before submission.

Get Answers on Icici Pay Direct Card

What is the ICICI Pay Direct Card?

The ICICI Pay Direct Card is a meal card designed to provide employees with a convenient way to access meal allowances. It is typically issued by employers to their staff and can be used at various merchant locations that accept meal cards. This initiative simplifies the process of meal reimbursements.

What are the eligibility requirements for applying for the card?

To qualify for the ICICI Pay Direct Card, applicants must be employees of a company that has partnered with ICICI Bank for this service. Basic requirements include providing personal details, identity proof, and employment verification from the employer. It’s essential that the information provided is accurate and up-to-date.

How do I fill out the application form?

The application form requires several mandatory fields to ensure proper processing. Applicants must include:

Personal details such as name, date of birth, and contact information.
Identity proof documentation.
Employment details, including the name of the company and department.

Make sure to provide a recent photograph and sign in black ink within the designated area of the form.

What documents do I need to submit with the application?

Applicants must submit one verified true copy of an identity proof document. The following documents are acceptable:

Passport
Driving License
Voter ID
Employee ID
PAN Card
Current credit card statement

For married women, documentation with the maiden name supported by a marriage certificate is also acceptable.

Are there any fees associated with the card?

Yes, there is a one-time fee of Rs. 200 for the issuance of the ICICI Pay Direct Card. This fee must be paid in the form of a Demand Draft made out to "ICICI Bank Limited." Attach this draft to your application form when submitting it.

How often can I use the Pay Direct Card?

The Pay Direct Card can generally be used for meal transactions until the balance is exhausted or monthly limits set by the employing organization are reached. It is important to be aware of your company’s specific usage policies regarding the card.

What should I do if I lose my Pay Direct Card?

In the event of a lost card, immediately contact ICICI Bank’s customer service to report the loss. Prompt reporting helps prevent misuse and allows the bank to block the card. A replacement card may also be issued, which typically requires a formal request and potentially a fee.

How do I close or cancel my Pay Direct Card?

If you wish to close your Pay Direct Card account, it’s essential to notify your employer and ICICI Bank directly. Complete any necessary procedures as outlined by your employer, and ensure all outstanding balances or transactions are settled before submitting a cancellation request.

Common mistakes

Filling out the ICICI Pay Direct Card form is an important task that requires attention to detail. One common mistake people make is failing to provide complete personal information. Each field marked as mandatory must be filled in accurately. Omitting critical details, such as the date of birth or contact information, can result in application delays or outright rejection.

Another frequent error involves the identity proof section. Applicants often submit documents that don't match the criteria specified in the form. For example, while a passport or employee identity card must be verified against originals, failing to include the required copies, or providing invalid identification can complicate the application process significantly.

Inaccurate or inconsistent information is another common mistake. If an applicant provides a name on the application that does not match the identity proof or differs in spelling, it can lead to confusion. For married women, using a maiden name without appropriate proof can particularly pose issues. Consistency is key when dealing with personal records.

Moreover, people sometimes neglect the declaration section. This part of the form is not only about agreeing to the terms but also about affirming that all provided information is true. Those who don’t carefully read or acknowledge this section risk facing legal issues later on. Ensuring that this declaration is complete and signed is crucial.

Lastly, many applicants fail to pay the card charges upfront as specified. The requirement to pay a one-time fee of Rs. 200 through a demand draft should not be overlooked. Not including the payment can lead to automatic rejection of the application. Proper preparation and payment are essential steps before submitting the form. Careful attention to these details can make a significant difference in the application experience.

Documents used along the form

The ICICI Pay Direct Card form is a comprehensive document that requires the submission of various supporting forms and documents to ensure a smooth application process. These documents provide essential information about applicants and verify their identities. Below are some of the forms that are often used in conjunction with the ICICI Pay Direct Card form, each serving a specific purpose.

Identity Proof Document: This is a verified true copy of any valid identification, such as a passport, driver's license, or voter ID. It serves to confirm the applicant's identity and is essential for validating the application.
PAN Card: The Permanent Account Number (PAN) card is crucial for tax purposes in India. If an applicant does not have a PAN card, a separate form must be submitted to explain the reason and provide the necessary details.
Address Proof Document: This document verifies the current residence of the applicant. It could be a utility bill, rental agreement, or another official document that confirms the address provided in the application.
Employer Verification Letter: A letter from the applicant's employer is often required to verify employment status. This document should include details about the applicant's position and department, helping to establish the connection between the employer and the card application.

These documents ensure that the application process remains efficient and thorough. By providing accurate and complete information, applicants can avoid potential delays in obtaining their ICICI Pay Direct Card.

Similar forms

The ICICI Pay Direct Card application form bears similarities to several other important documents. Each document serves a specific purpose, aligning with the card application process. The comparisons highlight shared characteristics and procedural elements.

Bank Account Opening Form: Like the ICICI Pay Direct Card form, this document requires personal information, identity verification, and the signatures of both the applicant and a bank official. Both are necessary for establishing a banking relationship.
Loan Application Form: This form functions similarly by collecting detailed personal and financial information. Applicants must also provide identity proof and declare their income and employment details, mirroring the requirements found in the Pay Direct Card form.
Credit Card Application Form: The ICICI Pay Direct Card application shares common fields with this form, such as personal and employment details, income proof, identity verification requirements, and declarations confirming the accuracy of the provided information.
Employee Benefits Enrollment Form: This document often mirrors the Pay Direct Card form in collecting personal details and employer confirmation. Both require verification of eligibility for benefits or services based on provided documentation and identity proof.
Tax Identification Number Application: Similar to the Pay Direct Card form, this application necessitates personal information, an identity verification process, and declarations regarding the truthfulness of the submitted information. Both documents play vital roles in ensuring compliance with regulatory requirements.

Dos and Don'ts

When filling out the ICICI Pay Direct Card form, keep these key dos and don’ts in mind to help ensure everything goes smoothly.

Do fill in all mandatory fields completely and accurately.
Don’t leave any required information blank—this can delay your application.
Do include a verified true copy of an acceptable identity proof.
Don’t submit an identity proof that is expired or not clearly legible.
Do sign the application using black ink as specified.
Don’t forget to affix a recent photograph in the designated area.
Do provide your current contact information so the bank can reach you.
Don’t ignore the terms and conditions—review them carefully before submitting.
Do keep a copy of your completed application for your records.

Following these guidelines will help facilitate a smoother application process for your ICICI Pay Direct Card.

Misconceptions

Misconception: All fields in the form are mandatory. Not all fields are required to be filled out. Only those marked with an asterisk (*) are mandatory. Ensure you complete these to avoid delays.
Misconception: Any valid ID can be submitted. Only specific types of identity proofs are accepted. Make sure to provide a verified true copy of one of the listed documents.
Misconception: The application can be submitted without a signature. Your signature is crucial. It confirms your agreement to the terms and conditions and verifies your identity.
Misconception: The payment can be made in any format. The card fees must be paid via Demand Draft, specifically drawn in favor of "ICICI Bank Limited." Other payment methods are not acceptable.
Misconception: Past insolvency is irrelevant. If you have had insolvency proceedings, it is important to disclose this information. Failure to do so can affect your application.
Misconception: Terms and conditions are static. Terms and conditions may change over time. Regularly check the ICICI Bank website to stay informed of any updates related to your card.
Misconception: No tracking of changes is needed. It is necessary to inform ICICI Bank about any changes in your residence or employment. This maintains your account's integrity and benefits.
Misconception: Employers cannot reverse instructions. Your employer has the right to reverse any instructions regarding your card within three working days. You cannot dispute this action.

Key takeaways

When completing the ICICI Pay Direct Card form, it’s essential to be thorough and precise. Here are seven important points to keep in mind:

Mandatory Fields: Ensure that all required fields, marked with an asterisk (*), are filled out correctly. Missing information can lead to processing delays.
Identity Proof: A verified copy of a valid identification document is necessary. This verification must be done by a bank official.
Correct Personal Details: Double-check personal information such as your name, date of birth, and address. Errors in these details may cause complications later on.
Application Fees: Remember to include the one-time fee of Rs. 200 suitable in the form of a Demand Draft favoring “ICICI Bank Limited.” Without this payment, the application cannot be processed.
Signature Requirements: Sign the application in black ink within the specified box. Your signature needs to match the one on your identification documents.
Declaration Acknowledgment: By signing the declaration, you confirm that the information you’ve provided is accurate. Misrepresentation may lead to rejection of the application.
Updates on Employment: If your employment status changes, notify ICICI Bank promptly. This ensures you maintain your benefits related to the card.

By keeping these key takeaways in mind, you can streamline the process of obtaining your ICICI Pay Direct Card and avoid potential setbacks.