Bisbee as Nig I SAL 2 SeP | { @ PCE Bank ao AD ROL SISSS camo seman CP AOIZIS SS t apa “Sudarshan Rao Current ful eadroas: A2R)Y QO 50: Permanont jot address: TSuiiaingiabe Name = [Sirest 7 Area pens '0d * Postod, [DESIGNATION PyStal ANTE NS —_CTIPRUQA | Office full address: TeuliginavAnt Nemne : (treat Area? mS sie Ne Panel Pas poblate kaa Lay.Department Of Posts Pay Slip For The Month Of August 2023. Name + ADAPA VIJAY Office + VISAKHAPATNAM Emp 1d + 62102429 Level-Index 04.06 Designation: POSTAL ASSISTANT PAN + DKKPA7770N GPF/PRANNO : 132002445236 Earnings ‘Deductions Out OfAccount Basic Pay, 45500.00| NPS Contribution 3355.00] Prof.Tax 200.00} Dearness Allowance 4700.00] ' CGE GIS Savings Fund 90.00) Union/Association 50.00 Subseri DA onTPA 450.00| CGHS 250.00 ‘HouseRent Allowance 4500.00 “Transport Allowance 2500.00 Cycle Allowance 150.00} Total 57800.00| Total 3695.00 Total 750.00] Take Home Pay : Rs.53,855.00/- FIFTY THREE THOUSAND EIGHT HUNDRED FIFTY FIVE RUPEES ONLY. Type ‘Amount ‘NFPEPMAN & GRD 50.00 BevinCommon-Application-Formn a ICICI Bank for esas aa est io : Application ID* hereby provide my consent to ICICI Bank to process my application for the below selected credit card: B el ae & [| _1ot Bank Coral Credit Card ee TGIG Bank Platnum Chip Credit Card [| Visa i < Nt {CIC Bani HPCL Coral Groct Card [Vis | Rx 100 + GST | Ra 109 + GST i “Accelero ICICI Bank Credit Card Vise He50 + GST| Asas9 + GST fi Manchester United Plat i ime Foo of R= iad Patna Ged | vag | mao +ost | ream +ast | ™ soo'asr ‘Manchester United Signature Credit ‘One Time Fee of Rs. coin " Visa Rs. 2,409 +GST | Rs. 2,499 + GST too + ast MakaMyrip Tl Gna Timo Fee of = Bank Signature Credit Card Mise Fe. 2,600 + GST bas 250 + GST, MakaMyTeip ICICI One Time Fee of Bank Platinum Credit Card eel Rs. 500 + GST La 250 + GST TC Barr Foe plo, Rs 49+ 6ST Mine Credit Card by ICI Bark Visa NL Pro 49 plan, Re 148 wi Por Premium 149 L olan a {GIGI Bank HFCL seo + GST ima Foo of Re 7 ap teerommcas “| Venu Mose” uy 00+ 6st Tories ICI Bank Sapphiro = sooo nes | ha 2504S ic ek vi es000+ 6st | 5.5 a ae SETS RG Sea MIR HT a ai wi ar var | AOS ib appeablogn ei and Arve! Fee ‘lam submiting the income Proof documents as mentioned below for futher processing ofthis application. iE Tncéme Proof 1 Income Proof 2 ] Document Name Reference No. Document Name: Reference No. B ® Pow sie? Tam eubmiting the KYC documents to CII Bank Sta) as marioned below for furor probessing of tis application. Idonttyiaddress Proof! Idontiy/Address Proof? Document Name Reference No. Document Nome Reference No. i Thave authorized, the representative of ICICI Bank Limited having to enter the account opering dt pper the insructons given by me in the electronic epplication form. Fee acarvcriewed and verifed te details entered by tinvher in the electric application form and declare tho same to That Neve fotand updated and the application number mentioned above wit respect to the electronic application form fos bese gonorated by ICICI Bank post my review, verification and confirmation of the application deta, i eee son elocvonie application orm and physical confirmation form together shall conssitute credit card application form for the application number mentioned above Fee cee icaderstood and horeby agree to Terms and Conditions and MITC (Most Important Terms and Conditions) Zpplicable to my eredit card epplication set forth on the website wowicicibankcom. | understand that access f0 any cRenseskupdation in Terme and Conditions applicableto this applicationwould be availablaon the wabsite only. v. Louttore cic! Bank to exchange, share of part with all the information relating to me and repayment history to credit bunonus, agencies, stansory bodies, market research agencies for conducting research as may be required and shall not old ICICl Bank (or market research egencies) Hable for use/sharing of this information; and share Card application dot nd stats, Card account satus, reward details and Card activity data with its affiliates foritto update its records to provide services & benefits with respect to the Card. vi. Ihave no objection to cl Bank Limited, its group companies, agents/representatives to provide me information on various product, offers and services provided by ICICI Bank Limited/ts group companies tough any mode Gincluxting without the undersigned declare, confirm and agree: ‘on my behalf and aslimitation trough telephone calls/SMSs/e-mails) a ‘genterepresentatives for the above purpose. ([]¥es /11 NO Weta a ee vee er ee eer ai afliates and/or associates ([] Yes /[] No) er ci stow, compares. ee daree. Manchester Urited I hereby consent to ICICI Bank Ltd. sharing my Name, Contact Detail ear First Purchase and Dato of Last Purchase nese ences United Foatall Cub Linted and ter aftces sere ce of marketing, curated offers etc. ([] Yes /[] NO} eae ix. Manchester United want youto be first to know about New Signings, Competitions, @fubs News, Tickets, ‘Availability, and occasional offers from offcial sponsors and partners. (I Yes /[} No) x. For MokeMyTrip ICICI Bank Credit Card: | hereby authorize ICICI Bank Ltd ("ICICI Bank’) to share my data or informstion associated with my MakeMyTrip ICICI Bank Credit Card (Cord application’) () registered E-mail ID; (i) registered Mobile frumber; (ii) Card variant availed ofPlatnum/Signature); Gv) Credit Card account no. with MakeMyTrip Ondia) Private Limited and its afiiates ('MMT*) to update its records and provideme services, rewards & benefits wit respect tothe Card. xi. For MakeMyTrip ICICI Bank Credit Card: I hereby agree that in case the e-mail ID provided by me in the Card application does not have a corresponding MMT account, MMT shall provideme with services, rewards & benefits associated with the Card on my MMT account linked to my registered mobile number. In case my email ID or mobile number are not present inany MMT account, MMT shall create anew MMT account on my behalf with my e-mail ID and/or mobile number, provided under the Card application. MMT shall update me with details of the new MMT account and steps to access the new MMT ‘account by way of an SMS and/or email. xii, InterMiles Membership: IWe authorize ICICI Bank to exchange, share or part with allthe information relating to me/us as contained in tis epplication form and/or the details of the InlerMiles ICICI Bank Credit Car, if any to be issued to me with the InterMiles Programme Partner and/or any other third party pursuant to ICICI Bank arrangement with InerMiles/JetPrivilege and/or any other third partyin relation to the InterMiles ICICI Bank Credit Card, as may be required foras ICICI Bank may deem ft end We shall not hold ICIC! Bank liable for use/sharing cof this information. Note: i you are fot an interMiles Member, you willbe automaticaly enrolled Also, if we do not receive your existing InterMiles membership humber in this applicationform. anew InterMiles membership number willbe alloted to you and linked to your Credit Card. Please note that by applying for the InteMiles ICICI Bank Credit Cerd you are consenting to the Terms and Conditions of membership ofthe InterMiles programme. These canbe found at www intermiles.com IGicl Bank Rewards powered by PAYBACK: You hereby authorize ICICI Bank Ltd (ICICI Bank?) to share your data or information associated with your ICICI Bank Credit Card (Card application’ () Name (i) E-Mail 1D (i) Mobile umber (i) Herre birth Gu) Address (vi) Credit Cord Account number with Loyalty Solutions and Research Pvt. Ltd. and its affiliates (LSRPL} to update in your PAYBACK account and provide services and benefits with respect to the PAYBACK reward programme on your ICICI Bank Credit Card. Por tnore information regarding information disclosures, please check ICICI Bank Card Terms & Conditions, ize ICICI! Bank Limited, fs group companies, baw: |S, 4-23 Pace: vica bhapitnans Primary Card Applicat Sign INCOME DOCUMENTS CERTIFICATE (To be Filled by the Executive) 7 © Ihave metNtriMts_[A =P inpersonathisher residenceloficefbranch and hereby confirm thatthe Income documents collected from |) ras produced by the applicant. also confirm bat the frm has been signed by the Spplicantin my presence. Toad tere Q GhAYGaU | womens EYE. CERTIFICATE (To be Filled by the ICICI Bank Staff) Ti. Executive Emp. Code jin person sidencelofficefbranch and hereby confirm the identity Ihave met Mr/Ms, inperson at hisier residenceloffice/b y | have diese provided in the application matches against originals as produced by the applicant. The Income documents a a add fom the applicantas produced by the applicart. also confirm thatthe form has been signed By the applicantin my presence. [tcc Bank Emp. Name: Til ICICI Bank Employee Signature TIGICL Bark Emp.Code: i Equivalent Documents 0 Certified DE:KYC data Data received from 1 Digital KYC a received copies fecelved from offine verification process edocument UDA