Page 1 of 6 M-76543125-1

187302/76543125-1/1-6/RESGB/11-15
Your Base Branch : NASHIK-KALIKA MANDIR
ROAD BRANCH, B 1-3 AND B 29-31, OPP TO
KALIKA DEVI MANDIR, GADKARI CHOWK,OLD
MR.YASH YOGESH PATIL MUMBAI-AGRA ROAD, 422001
104,KRUSHNA RESIDENCY,TRIKONI GARDENKATHE,
DWARKA,BANKAR MALA
NASHIK
: Visit www.icicibank.com
MAHARASHTRA - INDIA - 422011 Å Dial your Bank 1860 120 7777

Never share your OTP, URN, CVV or passwords with anyone, even if the person claims to be a Bank employee.

STATEMENT SUMMARY for Customer ID : XXXXX7780 as on September 30, 2022

ACCOUNT DETAILS - INR

ACCOUNT TYPE A/C. BALANCE (I) FIXED DEPOSITS (LINKED) BAL. (II) TOTAL BALANCE (I+II) NOMINATION
Savings A/c XXXXXXXX4388 1,32,160.05 0.00 1,32,160.05 Registered

TOTAL 1,32,160.05 0.00 1,32,160.05

Statement of Transactions in Savings Account XXXXXXXX4388 in INR for the period September 01, 2022 - September 30, 2022

DATE MODE PARTICULARS DEPOSITS WITHDRAWALS BALANCE

01-09-2022 B/F 8,794.40
UPI/224454594033/Payment from Ph/rohitsuryawansh/Axis Bank
01-09-2022 154.00 8,640.40
Ltd./AXLe74c928e0dc241c99caa8d6677bfb944/
UPI/224476704299/Payment from Ph/rohitsuryawansh/Axis Bank
01-09-2022 107.00 8,533.40
Ltd./AXLe8d52ffb3278479f8c9a92030f94085d/
UPI/224497930757/DS Tailor/Q407014680@ybl/Kotak Mahindra
01-09-2022 1,400.00 7,133.40
/AXIebfc7fc728c841c48e46cc0d964aecb4/
UPI/224465769026/Payment from Ph/paytmqr28100505/Paytm
01-09-2022 36.00 7,097.40
Payments /IBL30afc37fe9a445c794e0fef2790cd278
UPI/224486709890/Payment from Ph/8669557716@ybl/Bank of
01-09-2022 200.00 6,897.40
Baroda/YBL9bc49fa8e4a746a4a1de02b38b31a6a1/
UPI/224485246802/Payment from Ph/paytmqr28100505/Paytm
01-09-2022 55.00 6,842.40
Payments /YBL0ef1430f17bc4974ae920a389642c2a7
UPI/224471498366/Payment from Ph/yashu.yp.345@ax/Axis
01-09-2022 255.00 7,097.40
Bank Ltd./AXL9e59c630a5b44521884fa9f335895af8
UPI/224541157282/Payment from Ph/paytmqr28100505/Paytm
02-09-2022 332.00 6,765.40
Payments /IBL06b64af90157415190d71382f087ee82
UPI/224553024752/Payment from Ph/Q07702296@ybl/Yes Bank
02-09-2022 600.00 6,165.40
Ltd/YBL20fcf00c93ae41d5a541c7f946e9ec0b/
UPI/224585876888/Payment from Ph/Q435392461@ybl/Yes
02-09-2022 120.00 6,045.40
Bank Ltd/YBL31b1cc2ec0b0485e997598af06077461/
UPI/224559604851/Payment from Ph/Q09252255@ybl/Yes Bank
02-09-2022 12.00 6,033.40
Ltd/YBLfec414cfc74842bbbcc949b204820a00/
UPI/224537376322/Payment from Ph/yash31.yp@ybl/ICICI
02-09-2022 36,000.00 42,033.40
Bank/YBL00fd00e79c9d40c0b76c36812b7d3e8b
02-09-2022 NET BANKING VIN/Freecharge /202209021738/224512424506/ 41,839.20 194.20
UPI/224560653121/Payment from Ph/paytmqr28100505/Paytm
02-09-2022 45.00 149.20
Payments /IBL27093e9fb4e34ebba58309e33479cc02
UPI/224697160170/Payment from Ph/paytmqr28100505/Paytm
03-09-2022 40.00 109.20
Payments /YBL22b16736926045798604e54a205c1e77
UPI/224644296014/Payment from Ph/yash31.yp@ybl/ICICI
03-09-2022 20,000.00 20,109.20
Bank/YBLe47c6476ca2344bc8b49ddc9bfea2c03
UPI/224627054324/Payment from Ph/paytmqr28100505/Paytm
03-09-2022 20.00 20,089.20
Payments /IBL4e50aae0a63e40848f66ac254dff6a89
03-09-2022 DEBIT CARD VPS/RUSHABH HON/202209031603/224610419996/NASIK 1,000.00 19,089.20
NEFT-010448202009-MEDINOVA SUPER SPECIALITY
03-09-2022 64,800.00 83,889.20
HOSPITAL-SALARYAUG22-328921010000072-UBIN0932892
UPI/224647369916/Payment from Ph/7387657036rsrs@/Axis
03-09-2022 800.00 84,689.20
Bank Ltd./IBL92baabc1d9f0437ea750978da5d0fd2d
UPI/224770523774/Payment from Ph/paytmqr28100505/Paytm
05-09-2022 279.00 84,410.20
Payments /IBLe1dfe41d70b341df8691616edc1f72ee
UPI/224737261839/Payment from Ph/yashu.yp.345@yb/Axis
05-09-2022 279.00 84,689.20
Bank Ltd./YBLa17021066e7a4bc584794efee12bdd5d
UPI/224790052182/Payment from Ph/9834328970@ibl/State
05-09-2022 30.00 84,659.20
Bank Of I/IBLfc6163a8ff964543924533fc333c27fb/
05-09-2022 DEBIT CARD VPS/DMART AVENU/202209041221/224706696693/NASHIK 7,893.97 76,765.23
UPI/224773400393/Payment from Ph/dmartindia14378/ICICI
05-09-2022 29.00 76,736.23
Bank/IBL1e143c45d5d44430901553f40fa7c94e/
UPI/224798743018/Payment from Ph/9823267825@ybl/State
05-09-2022 6,000.00 70,736.23
Bank Of I/YBL86b68df6a6054176b865ce37f0ba2756/
Total: 1,22,134.00 60,192.17 70,736.23
 Page 2 of 6 M-76543125-1

Statement of Transactions in Savings Account XXXXXXXX4388 in INR for the period September 01, 2022 - September 30, 2022

DATE MODE PARTICULARS DEPOSITS WITHDRAWALS BALANCE

UPI/224775750300/Payment from Ph/8379043472@ybl/State
05-09-2022 1,000.00 69,736.23
Bank Of I/YBLfebd852cb75b414885bbd082d08a90a0/
UPI/224785560625/Payment from Ph/paytmqr28100505/Paytm
05-09-2022 165.00 69,571.23
Payments /IBL6b9e95477c4e445d89ab1f98615c653e
UPI/224779278927/Payment from Ph/Q772206140@ybl/HDFC
05-09-2022 20.00 69,551.23
BANK LTD/YBLc3dfd48c28094a748d38738d02b6feab/
05-09-2022 LPNASXX40514 SEP22 Yash Yogesh 13,144.00 56,407.23
UPI/224882782362/Payment from Ph/paytmqr28100505/Paytm
05-09-2022 100.00 56,307.23
Payments /IBL74b71e5d93bd43bd95149cb3c046a278
05-09-2022 CASH DEPOSIT CAM/09991ORY/CASH WDL/05-09-22 6,000.00 50,307.23
UPI/224897830569/Payment from Ph/9823267825@axl/State
05-09-2022 1,000.00 51,307.23
Bank Of I/AXLfb13eb3d36604d78a678cd46213ce5a2
05-09-2022 DEBIT CARD IPS/J R MEHTA A/202209052055/000000018266/NASIK 2,000.00 49,307.23
MMT/IMPS/224823064771/5NRDH1K9LCZPVIG/Amazon
05-09-2022 MOBILE BANKING 599.00 49,906.23
Sel/HSBC Bank
06-09-2022 SMSChgsJul22-Sep22+GST 17.70 49,888.53
UPI/224923213331/Payment from Ph/rohitsuryawansh/Axis Bank
06-09-2022 50.00 49,838.53
Ltd./AXLf77a6148928344c6ace685b6503ecb97/
UPI/224917075739/Payment from Ph/rohitsuryawansh/Axis Bank
06-09-2022 1,000.00 48,838.53
Ltd./AXL3d50cf73059d4ede9e3b5b98c22ca122/
06-09-2022 DEBIT CARD VPS/UDUPI TADKA/202209061551/224910983850/NASHIK 927.00 47,911.53
UPI/224995717628/Payment from Ph/7387657036rsrs@/Axis
06-09-2022 100.00 47,811.53
Bank Ltd./YBLe10f5cf1601f40b5a67db4344349ba22/
UPI/224944257378/Payment from Ph/rohitsuryawansh/Axis Bank
06-09-2022 50.00 47,761.53
Ltd./AXL8b1e7d042c8540ccbd5a610de98f7712/
UPI/224908137821/Payment from Ph/paytmqr28100505/Paytm
06-09-2022 50.00 47,711.53
Payments /IBL349cb6f7d3f844cb94604e0fa4a11dee
UPI/224968359327/MSEDCL/bdgpay.msedcl@h/HDFC
06-09-2022 750.00 46,961.53
BANKLTD/HDFF9D3DABAEC974627AFF2EB0C524DF373/
UPI/224921512485/Payment from Ph/7387162407@axl/State
06-09-2022 70.00 46,891.53
Bank Of I/AXL2d788d9847054229b46dd224d2a13aca/
UPI/225051853499/Payment from Ph/yash31.yp@ibl/ICICI
07-09-2022 10,000.00 56,891.53
Bank/IBLdf2cb14a0a0048548c0743f81aa12d20
07-09-2022 NET BANKING INF/INFT/029245670271/MOTHERSON PHARM 30,000.00 86,891.53
07-09-2022 CHEQUE 925 CLG/YASH YOGESH PATIL/HDF 20,000.00 66,891.53
07-09-2022 ICICI ATM ATM/SACWK902/CASH WDL/07-09-22 20,000.00 46,891.53
07-09-2022 ICICI ATM ATM/SACWK902/CASH WDL/07-09-22 10,000.00 36,891.53
UPI/225089570519/Payment from Ph/Q735896744@ybl/Yes
07-09-2022 35.00 36,856.53
Bank Ltd/YBL8d2ec18df1f74a22ba71ab7c203f78be/
UPI/225142725989/Payment from Ph/paytmqr28100505/Paytm
08-09-2022 50.00 36,806.53
Payments /YBLf24a71d0126c4d1eb98a44597b45635c
UPI/225176829314/Payment from Ph/Q168358827@ybl/Kotak
08-09-2022 1,400.00 35,406.53
Mahindra /YBL4f873cccb5794431987f17da4cdcae73/
UPI/225168549823/Payment from Ph/Q568751805@ybl/Yes
08-09-2022 60.00 35,346.53
Bank Ltd/YBL5f40a7ba7cdf4536b49fd813187cc217/
08-09-2022 DEBIT CARD VPS/UDUPI TADKA/202209082232/225117261324/NASHIK 1,288.00 34,058.53
UPI/225284898639/Oid19005952788@/paytm-648052425/Paytm
09-09-2022 1,000.00 33,058.53
Payments /PTMdc66f872efa1489d87128e1ed2abd36b
UPI/225284921786/OidP044-P044302/paytm-64752817@/Paytm
09-09-2022 303.20 32,755.33
Payments /PTM492606b3619a4c8d893e755449b41113
UPI/225248194469/Payment from Ph/reliancetrends./HDFC
09-09-2022 1,049.00 31,706.33
BANK LTD/YBLcdfd3a5658db41f38a466ff93a5fe2ed/
UPI/225234620134/Oid849019916537/paytm-66508080@/Paytm
09-09-2022 999.00 30,707.33
Payments /PTMf14e47c8968744eab0faa00330d301ec
UPI/225270531449/Payment from Ph/Q68020218@ybl/Yes Bank
09-09-2022 965.00 29,742.33
Ltd/YBLcd58178eaec3407ea8d870fdcce2b193/
UPI/225236139134/Payment from Ph/starbazaar.4234/HDFC
09-09-2022 399.00 29,343.33
BANK LTD/YBLa0669955cf48495d87c8776fbf5132e0/
UPI/225265396668/Verified Mercha/BHARATPE.905235/Federal
09-09-2022 60.00 29,283.33
Bank/AXLd302a8acddb444b3ae821103400fbdac/
UPI/225294939878/Payment from Ph/paytmqr28100505/Paytm
09-09-2022 480.00 28,803.33
Payments /AXL6d05774fb35e4d08a4ab41da74461bb7
UPI/225273296437/Pay to BharatPe/BHARATPE.900613/Federal
09-09-2022 30.00 28,773.33
Bank/YBL700a2658846e41ee8fce95bac1dbe754/
UPI/225207178441/Payment from Ph/7387657036rsrs@/Axis
09-09-2022 35.00 28,738.33
Bank Ltd./IBL68c86cdb07494353af0d7f0d2d12ee7f/
UPI/225237753571/Payment from Ph/Q697604454@ybl/Yes
09-09-2022 77.00 28,661.33
Bank Ltd/YBLb0d29417afec4f7694966bee0feb7d35/
UPI/225219636540/Mobilerecharge/newlifepharma@u/Union
09-09-2022 393.00 29,054.33
Bank of I/UOB19d1e3a4505a4448a982d44aa190e3e3
UPI/225210574068/F07 Credit by P/phonepe-payouts/Yes Bank
09-09-2022 1,000.00 30,054.33
Ltd/YESBE7DDF4C0DFD24F53E05400144FF9DBF
UPI/225216457192/Payment from Ph/yash31.yp@ibl/ICICI
09-09-2022 10,000.00 40,054.33
Bank/IBL4903141132ea4e9fa6eea66585dfde7b
Total: 52,992.00 83,673.90 40,054.33
 Page 3 of 6 M-76543125-1

Statement of Transactions in Savings Account XXXXXXXX4388 in INR for the period September 01, 2022 - September 30, 2022

DATE MODE PARTICULARS DEPOSITS WITHDRAWALS BALANCE

UPI/225257991910/Payment from Ph/Bank Account XX/Axis
09-09-2022 10,000.00 30,054.33
Bank Ltd./IBL23df1c7de2c3483daf1d3544924e09e2/
UPI/225383036798/Payment from Ph/BILLDESKPP@axl/Axis
10-09-2022 241.00 29,813.33
Bank Ltd./AXL0f63b353c134437bbb54f58bec707ea1/
UPI/225321012384/Payment from Ph/vidnyanapalyagh/Bank of
10-09-2022 30.00 29,783.33
Maharas/AXL7a8ef5f73e7c418daefd313e38560525
UPI/225345401163/Payment for 501/WELLNESSFOREVER/Yes
10-09-2022 29.99 29,753.34
Bank Ltd/YBL6ddff8fc01af4a6188077619cd11cae9/
UPI/225343652529/Payment from Ph/Q621479263@ybl/Kotak
10-09-2022 120.00 29,633.34
Mahindra /YBLcb665a39792042a39acd08da8a73a824/
10-09-2022 NET BANKING INF/INFT/029290994021/MOTHERSON PHARM 2,000.00 31,633.34
12-09-2022 ACH/HDFC BANK LIMITED/0000131190691 28,789.00 2,844.34
UPI/225415518255/F07 Credit by P/phonepe-payouts/Yes Bank
12-09-2022 50,000.00 52,844.34
Ltd/YESBE7DDF7C976522EFAE05400144FFACDE
UPI/225496392116/Payment from Ph/7387657036rsrs@/Axis
12-09-2022 1,500.00 54,344.34
Bank Ltd./IBL9dfa7d6c38324717b734f79031479491
UPI/262019022541/Payment from Ph/yashpatil311@yb/HDFC
12-09-2022 5,000.00 59,344.34
BANK LTD/YBL656a7b94878740a1b02b5b3970674295
UPI/225485971135/Payment from Ph/yashpatil311@yb/HDFC
12-09-2022 5,000.00 64,344.34
BANK LTD/YBL67bdfd9e5a1e46cfb6eb9b42c0f29fb8
UPI/225438262030/Payment from Ph/yashpatil311@yb/HDFC
12-09-2022 5,000.00 69,344.34
BANK LTD/YBLeb4b57fc6d4f4e32911d224205588d6a
12-09-2022 BIL/INFT/000488851992/NA/ MOTHERSON PHARM 69,000.00 344.34
12-09-2022 NET BANKING INF/INFT/029294731431/MOTHERSON PHARM 1,10,000.00 1,10,344.34
12-09-2022 NET BANKING BIL/000488856563/ICICI BANK CREDIT CA/431581156970 1,08,249.70 2,094.64
12-09-2022 NET BANKING BIL/000488856975/ICICI BANK CREDIT CA/437551389050 148.00 1,946.64
UPI/225517359210/F07 Credit by P/phonepe-payouts/Yes Bank
12-09-2022 50,000.00 51,946.64
Ltd/YESBE7DE52AEDED84E2AE05400144FF9DBF
UPI/225517595444/F07 Credit by P/phonepe-payouts/Yes Bank
12-09-2022 50,000.00 1,01,946.64
Ltd/YESBE7DDE8B33DE2227CE05400144FFACDE
12-09-2022 BIL/INFT/000489399832/NA/ MOTHERSON PHARM 1,01,000.00 946.64
UPI/225526684847/UPI Payment/584318846@icici/ICICI
12-09-2022 5,118.00 6,064.64
Bank/ICIee4eca1a7cee44198b3c98f3bc198422
UPI/225517705126/F07 Credit by P/phonepe-payouts/Yes Bank
12-09-2022 40,000.00 46,064.64
Ltd/YESBE7DDF3B82B264E95E05400144FF9DBF
12-09-2022 BIL/INFT/000489427511/NA/ MOTHERSON PHARM 45,000.00 1,064.64
UPI/225582134783/Payment from Ph/9823267825@ybl/State
12-09-2022 32,102.00 33,166.64
Bank Of I/YBLadf62b6f89004fbb940b3b7e6bbd4a51
12-09-2022 BIL/ONL/000489593496/State Bank/SBICARD_YICI140 32,102.00 1,064.64
14-09-2022 CLG/MEDINOVA SUPER SPECIALI/023921/UBI/12.09.2022 55,000.00 56,064.64
UPI/262350837663/Payment from Ph/sara99999@axl/Axis Bank
14-09-2022 3,698.00 59,762.64
Ltd./AXL84a0f5d5436f4cb1bcbb96fcf4d10b3e
UPI/225777175044/UPI Transaction/makemytrip.payu/HDFC
14-09-2022 3,498.00 56,264.64
BANK LTD/NF7W41VC7A2PQZ2Q6814A2/
UPI/262341030193/Payment from Ph/Q12194678@ybl/Yes Bank
14-09-2022 20.00 56,244.64
Ltd/YBL69682dc8798948d1a84bda5b6983243c/
UPI/225724582749/Payment from Ph/dominospizzaonl/Paytm
14-09-2022 162.00 56,082.64
Payments /PYTM20220914363193184573/
14-09-2022 BIL/INFT/000490793332/NA/ MOTHERSON PHARM 30,000.00 26,082.64
14-09-2022 BIL/INFT/000490793937/NA/ MOTHERSON PHARM 10,000.00 16,082.64
BIL/INFT/000490794543/HOUSE RENT AUGU/ SHEELA BHARAT
14-09-2022 7,000.00 9,082.64
P
UPI/225742933110/nasik to mumbai/9405275065@ybl/Bank of
14-09-2022 3,500.00 5,582.64
Maharas/YBL9be86b6b159f4a4382c3ea889ca755c8/
UPI/262477784887/for milk/7387657036rsrs@/Axis Bank
15-09-2022 70.00 5,512.64
Ltd./YBL8d626ba730544d8d9e85dc8e8b239843/
UPI/225857103648/Payment from Ph/9890060778@axl/The
15-09-2022 77.00 5,435.64
Cosmos Co-O/AXL05da6f0bd6a24c6590076b5b077c8eb1/
UPI/225820952918/Swiggy Order Id/swiggyupi@axisb/Axis Bank
15-09-2022 146.00 5,289.64
Ltd./AXISSDKV3dc3c8f97a47d4ec48bc39922af/
UPI/225888795521/Payment from Ph/8888076764@axl/Bank of
15-09-2022 200.00 5,489.64
Baroda/AXL051b16626a0d4841bf8fe75ba34cd898
UPI/225833113983/UPI Payment/redexexpress201/ICICI
15-09-2022 630.00 6,119.64
Bank/ICI3cd3907541144a9aa8462a9e780b2b32
UPI/262464209111/Payment from Ph/rohitsuryawansh/Axis Bank
15-09-2022 350.00 5,769.64
Ltd./AXL2ce297931f2540488057bbb99d3ba7bb/
UPI/225827962570/Payment from Ph/7387657036rsrs@/Axis
15-09-2022 35.00 5,734.64
Bank Ltd./IBL6879537b5f2943df8ee2b4a2fc0e5cca/
UPI/225812904323/Payment from Ph/9890060778@axl/The
15-09-2022 35.00 5,699.64
Cosmos Co-O/AXLf66a54a977d7460a98e5e69b7a9e331a/
BIL/NEFT/000491821718/Flat104 Mainten/KRISHNA
16-09-2022 2,000.00 3,699.64
RE/COSB0000910
UPI/225931729503/Swiggy Order Id/swiggyupi@axisb/Axis Bank
16-09-2022 347.00 3,352.64
Ltd./AXISSDKV33a7e1bf34abc4e6491a3cb8f39/
Total: 4,15,248.00 4,51,949.69 3,352.64
 Page 4 of 6 M-76543125-1

Statement of Transactions in Savings Account XXXXXXXX4388 in INR for the period September 01, 2022 - September 30, 2022

DATE MODE PARTICULARS DEPOSITS WITHDRAWALS BALANCE

UPI/225919795001/Payment from Ai/airtelin.rzp@ic/ICICI
16-09-2022 589.00 2,763.64
Bank/APB666905825e6a4b7a9437b7ac88cf380a/
UPI/262603857444/Payment from Ph/rohitsuryawansh/Axis Bank
17-09-2022 1,000.00 1,763.64
Ltd./AXLc4f8591949984109aec8cda640409a36/
UPI/226098890064/Payment from Ph/paytmqr28100505/Paytm
17-09-2022 225.00 1,538.64
Payments /IBL12fd3a91fb5b49c3be5597d238e577fa
UPI/226089688648/Payment from Ph/7387657036rsrs@/Axis
17-09-2022 220.00 1,318.64
Bank Ltd./IBLadb21a83813242ba88f7a14b1662c4d4/
UPI/226094360431/Payment from Ph/8999804995@ibl/ICICI
17-09-2022 5,320.00 6,638.64
Bank/IBL87c2994c8f5e4b299f6c3c8b07bc887e
UPI/226094677535/Payment from Ph/yash31.yp@ibl/ICICI
17-09-2022 5,000.00 11,638.64
Bank/IBL4d57db329de549d387efda5f0bcb58f6
UPI/226096230457/Payment from Ph/makemytrip@icic/ICICI
17-09-2022 5,797.00 5,841.64
Bank/YBLe160009900bc4054a92277dd7f42030b/
UPI/262679325777/Payment from Ph/9823267825@ybl/State
17-09-2022 2,000.00 3,841.64
Bank Of I/YBLd933528247ac4d1692fd74bee4438170/
UPI/226098937982/Payment from Ph/sara99999@axl/Axis Bank
17-09-2022 5,797.00 9,638.64
Ltd./AXLbca86a2cd79d4c7f8665898a2d60c4e5
UPI/262743544497/Payment from Ph/9823267825@ybl/State
19-09-2022 5,000.00 4,638.64
Bank Of I/YBL7f2f6631d6f6428f866c0f12e5f448b2/
UPI/262733378533/Payment from Ph/sara99999@axl/Axis Bank
19-09-2022 19,793.00 24,431.64
Ltd./AXLad623ee7521b45a1ac7ce07dcb74f80d
UPI/226155025479/UPI Transaction/makemytrip.payu/HDFC
19-09-2022 19,793.00 4,638.64
BANK LTD/NF7PBD311D80WE334918A1/
UPI/262709588237/Payment from Ph/sara99999@axl/Axis Bank
19-09-2022 12,894.00 17,532.64
Ltd./AXL7d2d237b5d894396a33610e97affad0f
UPI/226136078172/UPI Transaction/makemytrip.payu/HDFC
19-09-2022 12,216.00 5,316.64
BANK LTD/NF7UUUPA48UQI6N56555A1/
UPI/262851880027/Payment from Ph/rohitsuryawansh/Axis Bank
19-09-2022 2.00 5,314.64
Ltd./AXLb64b65d41b4b402bbe8e6813827b0827/
UPI/226208074177/Payment from Ph/7387657036rsrs@/Axis
19-09-2022 100.00 5,214.64
Bank Ltd./IBL6628cfaa1f0e4903ae01ace2bb3d80f7/
UPI/226281452732/MakeMytrip/makemytrip.rzp@/Axis Bank
19-09-2022 4,619.00 595.64
Ltd./YBL4d1074ab16ff4a879704f81d0b22d7f5/
20-09-2022 ECSRTNCHGS070922_SR852558708 589.37 6.27
20-09-2022 NET BANKING INF/INFT/029397253581/MOTHERSON PHARM 60,000.00 60,006.27
UPI/226392493774/SBICARD/billdeskpg.sbic/HDFC BANK
20-09-2022 51,501.00 8,505.27
LTD/HDF3C23D3A8C6614C54AB0CA1B047D9A81C/
UPI/226411528640/Payment from Ai/airtelcommonpoo/Airtel
21-09-2022 589.00 7,916.27
Payments/APBa7c4eac7fdb54f59a7a6215d204e2f7f
UPI/263060309563/Payment from Ph/8379043472@ybl/State
21-09-2022 589.00 8,505.27
Bank Of I/YBLfafb2f14a24d40148c95fbd0ddf3d82f
UPI/226458614336/Payment from Ph/dominospizzaonl/Paytm
21-09-2022 460.00 8,045.27
Payments /PYTM20220921365154357669/
UPI/226487289469/Payment from Ph/7387657036rsrs@/Axis
21-09-2022 150.00 7,895.27
Bank Ltd./IBLd0b94068d17c4f01a5580c2ed39a7cb4/
UPI/226465544030/Swiggy Order Id/swiggyupi@axisb/Axis Bank
21-09-2022 151.00 7,744.27
Ltd./AXISSDKV3c6f5d9a93647449aae5e62f2be/
UPI/226402011095/Payment from Ph/yash31.yp@ibl/ICICI
21-09-2022 2,500.00 10,244.27
Bank/IBL3af1bca31ba248c8bdccf4076dd78294
21-09-2022 NET BANKING INF/INFT/029409369531/MOTHERSON PHARM 36,000.00 46,244.27
21-09-2022 NET BANKING INF/INFT/029409418201/MOTHERSON PHARM 24,000.00 70,244.27
UPI/226494429828/SBICARD/billdeskpg.sbic/HDFC BANK
21-09-2022 63,122.00 7,122.27
LTD/HDFDDDAEC0950C74304BD9606E0AE569E98/
21-09-2022 BANK CHARGES MNDT_CHRG~SMSOTP~16AUG2022~161548334H 118.00 7,004.27
UPI/226543768109/Payment from Ph/gpay-1119833224/Axis
22-09-2022 300.00 6,704.27
Bank Ltd./AXL18e2954c990240409ca9b1e3144a8dd9/
UPI/226526027722/Payment from Ph/upiswiggy@icici/ICICI
22-09-2022 146.00 6,558.27
Bank/AXL04b5378ea46d4ab9b39ad2e749a88293/
MMT/IMPS/226516354298/NA/RENENTECH
22-09-2022 MOBILE BANKING 2,175.30 4,382.97
/SBIN0004650/chgRs5.00GSTRs0.90
22-09-2022 MOBILE BANKING MMT/IMPS/226516354298/NA/RENENTECH /SBIN0004650 2,175.30 6,558.27
22-09-2022 BIL/NEFT/000496037403/NA/RENENTECH /SBIN0004650 2,169.40 4,388.87
UPI/263176697146/Payment from Ph/sara99999@axl/Axis Bank
22-09-2022 4,699.00 9,087.87
Ltd./AXL5ef2bf18d2ff4aac88d561c75929560b
UPI/263282172327/Payment from Ph/Q457047249@ybl/Yes
23-09-2022 500.00 8,587.87
Bank Ltd/YBL48a87ed8dd8d416cb9717ffd65d4aed0/
UPI/263246333658/Payment from Ph/rohitsuryawansh/Axis Bank
23-09-2022 25.00 8,562.87
Ltd./AXLf7c230fc09e54778b837638e6dd46c43/
UPI/263272965126/Payment from Ph/Q909495649@ybl/Yes
23-09-2022 1,500.00 7,062.87
Bank Ltd/YBL4e658fdf5d1e48b3a05c34b90acf7f8a/
UPI/263366068891/Payment from Ph/sara99999@axl/Axis Bank
24-09-2022 4,788.00 11,850.87
Ltd./AXL0684bd0635dc41a9a58f2e203c5891c8
UPI/263319007791/Payment from Ph/yashu.yp.345@yb/Axis
24-09-2022 100.00 11,750.87
Bank Ltd./YBL75972efed2ef462b95af8b19afe037f7/
Total: 1,83,555.30 1,75,157.07 11,750.87
 Page 5 of 6 M-76543125-1

Statement of Transactions in Savings Account XXXXXXXX4388 in INR for the period September 01, 2022 - September 30, 2022

DATE MODE PARTICULARS DEPOSITS WITHDRAWALS BALANCE

UPI/263368235556/Payment from Ph/7387162407@ybl/State
24-09-2022 70.00 11,680.87
Bank Of I/YBL58f10970b9e64d0b9360a44acb03e759/
UPI/263348341406/Payment from Ph/Q620463371@ybl/Yes
24-09-2022 62.00 11,618.87
Bank Ltd/YBL61f3296777364b259855cec4493e616c/
UPI/263421721674/flight canceled/sara99999@axl/Axis Bank
26-09-2022 688.00 10,930.87
Ltd./AXL3055e4f1e25a4b1ca2e98807f532f016/
UPI/226858766194/Pay for merchan/swiggy@yespay/Yes Bank
26-09-2022 243.00 10,687.87
Ltd/euliVtYEutGtq1WKEPs/
UPI/226839315547/Swiggy Order Id/swiggyupi@axisb/Axis Bank
26-09-2022 175.00 10,512.87
Ltd./AXISSDKV35aa8bff1eadc4b60ac4dd62fcb/
UPI/226856230098/Navratra Devi/pravinykhadye99/Bank of
26-09-2022 2,100.00 8,412.87
Maharas/ICI6f93e0a3523e41308bca80609d4119d8/
UPI/226921537171/mom medicine/7387657036rsrs@/Axis Bank
26-09-2022 126.00 8,286.87
Ltd./IBL017bbc93b3804d2caaada2acf2b7ebcf/
UPI/226901886639/milk/7387657036rsrs@/Axis Bank
26-09-2022 62.00 8,224.87
Ltd./IBLa262ff3fccf14b8caa7bb66f3534c96c/
UPI/226984095736/pizza for Rupa/7387657036rsrs@/Axis Bank
26-09-2022 390.00 8,614.87
Ltd./YBLa619e6b3890f496aad0defb805490908
UPI/226938234413/Payment from Ph/yash31.yp@ybl/ICICI
26-09-2022 5,000.00 3,614.87
Bank/YBLd9280636c4794c5faa70f0cf1144f524/
UPI/226955398314/Payment from Ph/yash31.yp@axl/ICICI
26-09-2022 3,500.00 114.87
Bank/AXLfc5a93691de347d199307bcafba8bd33/
UPI/226991281631/Payment from Ph/akshata1199@ybl/Axis
26-09-2022 3,000.00 3,114.87
Bank Ltd./YBL42bb7a123dd44131a206e96331201e6f
UPI/226974419839/Payment from Ph/yash31.yp@ibl/ICICI
26-09-2022 3,000.00 114.87
Bank/IBL99e2d768ef2a44caa0bc92f573eea41d/
UPI/227027039970/Payment from Ph/paytmqr28100505/Paytm
27-09-2022 10.00 104.87
Payments /YBL3443a177ec4b42928223a100a18562c2
UPI/263650702472/Payment from Ph/rohitsuryawansh/Axis Bank
27-09-2022 30.00 74.87
Ltd./AXL02e515a9ed7f497dbb03fe709d2ddcc9/
28-09-2022 NET BANKING INF/INFT/029476577761/MOTHERSON PHARM 1,50,000.00 1,50,074.87
UPI/227157173564/F07 Credit by P/phonepe-payouts/Yes Bank
28-09-2022 1,000.00 1,51,074.87
Ltd/YESBE915734799B81E3BE05400144FFACDE
29-09-2022 NET BANKING VIN/AIRTEL /202209291119/227205386577/ 440.00 1,50,634.87
UPI/227242227534/Payment from Ph/paytmqr28100505/Paytm
29-09-2022 35.00 1,50,599.87
Payments /IBL42504addbee94ee3bdd966fe334b6525
30-09-2022 187301504388:Int.Pd:30-06-2022 to 29-09-2022 668.00 1,51,267.87
UPI/227320280575/Payment from Ph/7387657036rsrs@/Axis
30-09-2022 150.00 1,51,117.87
Bank Ltd./IBL812f184aea284308ab24ab4d9b52bda3/
UPI/227376951251/Payment from
30-09-2022 Ph/SAMRATSPORTSAND/HDFC BANK 100.00 1,51,017.87
LTD/AXL540199b5fd374172b09ff1fc11be9c3e/
UPI/227354423426/Payment from
30-09-2022 Ph/Q524200412@ybl/Maharashtra 1,700.00 1,49,317.87
Gra/YBL2b607a4fb72b40eb8113b5076e7767e6/
30-09-2022 NET BANKING INF/INFT/029508768201/MOTHERSON PHARM 90,000.00 2,39,317.87
30-09-2022 NET BANKING BIL/000502137692/ICICI BANK CREDIT CA/431581156970 53,837.82 1,85,480.05
30-09-2022 NET BANKING BIL/000502138050/ICICI BANK CREDIT CA/474846131673 53,320.00 1,32,160.05
Total: 2,45,058.00 1,24,648.82 1,32,160.05

Summary of TDS/Interest on Fixed Deposits during the period September 01, 2022 - September 30, 2022

DATE OF
ACCOUNT INTEREST PAID/ TAX DEDUCTED
PAYMENT/
NUMBER CREDITED (INR) (INR)
CREDIT
Opening Balance (Cumulative) 403.00 0.00
Closing Balance (Cumulative) 403.00 0.00

Account Related Other Information

ACCOUNT TYPE ACCOUNT NUMBER MICR CODE IFS CODE NAME OF NOMINEE*
Savings XXXXXXXX4388 422229017 ICIC0001873 -

* Nominee name is displayed only on specific consent of customer.

Sincerely, Legends for transactions in your account statement

VAT/MAT/NFS- Cash Withdrawal at other bank's ATM INF - Internet funds transfer in linked accounts
EBA-Transaction at ICICIDirect BIL - Internet bill payment or funds transfer to third party
ICICI Bank Limited VPS/IPS-Debit card transaction TOP - Mobile Recharge
RTGS-Real Time Gross Settlement (Instant transfer above Rs 2 Lakh) NEFT - National Electronic Fund Transfer

This is a system-generated statement. Hence, it does not require any signature.

You can now download the account statement using the iMobile Pay app and Internet Banking.
 Page 6 of 6 M-76543125-1

l There is a revision in the service charge for domestic Savings Accounts w.e.f. Feb 01, 2022. l Do not fall prey to fictitious offers of winning prizes, money circulation schemes and cheap
For details, please visit https://www.icicibank.com/notice-board.page funds, etc. through SMS, e-mails and calls.
l There is a change in the terms and conditions for Salary Accounts. For detailed terms and l As per the prevailing guidelines of the Income Tax Act, 1961, if a valid PAN is not provided by
conditions, visit www.icicibank.com/managed-assets/docs/terms-condition/tnc-savings-account.pdf the customer, then the Form 15G/15H shall not be treated as valid and tax shall be deducted at
(Clause XV). the prevailing rate or at 20%, whichever is higher. PAN can be updated online or at the nearest
l Bank’s Code of Commitment to Customers and Micro and Small Enterprises (MSE): Please branch.
visit www.icicibank.com > About Us > Notice Board > Code of Commitment. The code l The address of the customer in Form 16A will be the last updated address in the data base of the
has been framed in line with the guidelines provided by Banking Codes and Standards income tax department.
Board of India (BCSBI).
l PMJJBY Insurance: The insurance premium is collected on behalf of ICICI Prudential Life
l As per guidelines issued by CBDT on May 13,2011, Form 16A (TDS Certificates) will be Insurance Company Limited plus administration charges collected by ICICI Bank (including GST),
generated through the Income tax website for which the PAN of the customer needs to be in line with extant laws. Effective Sep 01, 2018, a premium is charged on a pro rata basis for all
necessarily updated in Bank's record. new enrolments in the scheme. It is noteworthy that the renewal premium for all existing
l Each depositor is insured by the Deposit Insurance and Credit Guarantee Corporation customers shall be charged for a period of one year (i.e. Rs 330) on May 25 - May 31 every year.
(DICGC) up to a maximum of Rs. 5 lakh, for both principal and interest amount held by him For details on the premium structure, refer to the Terms & Conditions under the Pradhan Mantri
in the same right and same capacity. Social Security Schemes at www.icicibank.com.
www.icicibank.com
Corporate Office: ICICI Bank Ltd., ICICI Bank Towers, Bandra-Kurla complex, Mumbai - 400051, India. Category of service: Banking & Financial Services.
Registered Office: ICICI Bank Tower, Near Chakli Circle, Old Padra Road, Vadodara, Gujarat. Pin – 390 007. Registration No. MIV/ST/Bank & Finc/4.
CIN : L65190GJ1994PLC021012
This is an authenticated intimation/statement.
Customers are requested to immediately notify the Bank, in case of any error in the statement. SR201850771