Cust Req Online 2024 NOV

AUTHORIZATION FORM
CIF No: ______________________________

FOR OFFICE
Prepared by: ______________________________

USE
PERSONAL INFORMATION Verified by: ______________________________

CHANGE REQUEST Notes (if any):

* Mandatory field
APPLICANT INFORMATION
Title First Name * Middle Name Last Name *
Select...

Customer Identification Number *:

Don’t have your Customer Identification Number? We would be pleased to help at 1-888-424-2422

UPDATE MY INFORMATION (Please select all that apply)

HOME ADDRESS (Canadian Addresses Only) Please fill the address where you presently live. This address cannot be a postal installation i.e. PO Box, RR, Site, Comp or GD/General Delivery address.

Street Number and Name Apt. / Unit No.

City Province Postal Code Country

Select... CANADA
COMMUNICATION ADDRESS (if different from home address)

Communication Address Apt. / Unit No.

City Province Postal Code Country

Select or enter...
EMPLOYMENT INFORMATION

Name of Profession  Industry  Title 

Select... Select...
Primary Business Function   Click here to select, copy and paste the Primary Business Function in the field below; if not in the list, please enter below.

Employer Name 

 Required only if there are any changes or addition of information

Area Code Telephone Number

MOBILE NUMBER *: 001 * Canadian Mobile Numbers only. You must be the sole owner of this number.

Area Code Telephone Number

HOME PHONE NUMBER:

Area Code Telephone Number

BUSINESS PHONE NUMBER:

EMAIL ADDRESS: ______________________________________________________________________________________

AUTHORIZATION *

I/We hereby confirm that the information provided is true and correct.

I hereby consent to the Bank collecting, using and disclosing my personal information for the purposes identified in the Bank’s Privacy Policy, which I
have received, read and understood. I understand that ICICI Bank Canada reserves the right to carry out any other additional checks for verification
purpose on me.

_______________________________________________________ _______________________
APPLICANT SIGNATURE DATE (dd-mm-yyyy)

CLEAR FIELDS SAVE PRINT

 Contact us any time at 1-888-424-2422 or customercare.ca@icicibank.com.
Question? Thank you for helping us serve you better!

Once completed, please print, sign and mail the “Personal Information Change Request Authorization Form” to:
Mailing
Instructions ICICI Bank Canada
PO Box No. 47019, 220 Yonge Street
Toronto, ON M5B 2H0

INSTRUCTIONS:
1. Locate the Primary Business Function below and place the cursor at the beginning of the Primary Business Function
2. Highlight and copy the Primary Business Function
3. Click on the button “Return to Application” on the right side of this page
4. Once back in the Application, place the cursor on the Primary Business Function field and paste it

LIST OF PRIMARY BUSINESS FUNCTIONS FOR EACH INDUSTRY

Accounting, Tax, Legal Service Automobile dealers Computer systems design service Employment services
Bookkeeping, Payroll Services New car dealers Computer Systems Design Manpower Service Providers
Legal services Recreational vehicle dealers Computer related Services Professional Employer
Offices of accountants Used car dealers Data processing/Hosting Organization
Offices of Lawyers and Notary Data Related Services
Tax preparation services Automotive/Equipment rent/lease Facilities support services
Graphic design Services
Advertising and media services Construction Equipment Rent/Lease Video Game Design/Development
Transportation Equipment Rent/Lease Services to Building/Dwelling
Advertising services Mining Equipment Rent/Lease Construction Carpet and Upholstery Cleaning
Environmental Consulting Service Forestry Equipment Rent/Lease Duct/Chimney Cleaning Service
Marketing Research Building equipment Contractors
Consumer Electronic/Appliance Rent Exterminating/Pest Control Service
Public Opinion Polling Highway/Street/Bridge
Consumer goods rental Construction Facilities support Services
Media Agency & Representative General rental centres Janitorial Services
Photographic services Land subdivision
Office Machinery Rent/Lease Residential Building Construction Landscaping Services
Public relations services Office Equipment Rent/Lease Commercial Building Construction Window cleaning Services
Animal Production Commercial Equipment Rent/Lease Industrial Building Construction
Industrial Equipment Rent/Lease Specialty trade Contractors Farming and crop production
Animal Farming and Production Passenger Car Rent/Lease
Consulting services Farming and Crop Production
Truck Rent/Lease
Architectural/Engineering Service Utility Trailer Rent/Lease
Human Resource Consulting
Fin Services - Brokers/agents
Architectural services RV Rent/Lease
Immigration Consulting Service Financial Investment Activity
Building inspection services IT consulting Services
Drafting services Building material/supplies dealer Claims Adjusters
Management Consulting Services
Engineering services Building Material Supply Store Commodity Contract Dealing
Other consulting Services
Geophysical Surveying Hardware stores Professional Services Insurance Agency and Brokerage
Geophysical Mapping Services Home centres Scientific Services Invest. Banking/Securities Dealing
Industrial design services Nursery Store & Garden Centre Technical Services Investment consulting
Interior design services Outdoor power equipment stores Miscellaneous intermediation
Landscape Architectural Service Paint and wallpaper stores Dry Cleaning/Laundry Services Mortgage/Non-mortgage Loan Broker
Specialized Design Services Credit Intermediation Activity Portfolio
Surveying (except geophysical) Business support services Dry Cleaning/Laundry Services
management
Mapping (except geophysical) Educational services
Business service centres Securities brokerage
Arms and Ammunition Collection agencies
Convention/Trade Show Organizer Other Schools/Instruction Fin Ser - Pension/Other Funds
Explosives manufacturing Credit bureaus Athletic Instruction
All Other funds
Document preparation services Business & Secretarial Schools
Art Dealers Bond and income funds
Office administrative services Community College & C.E.G.E.P.s
Art Dealers Equity funds
Other Business Support Service Computer Training
Money market funds
Not For Profit Org/Association Packaging & Labelling Service Educational Support Services
Telephone call centres Mortgage funds
Elementary & Secondary Schools
Business associations Pension funds
Cannabis Related Activity Fine Arts Schools
Civic and social organizations Language Schools Financial Services - Regulated
Labour organizations Cannabis Farming Professional/Mgmt Training School
Other membership organizations Corporate Banking Industry
Cannabis Product Manufacturing Technical and Trade Schools Institutional Banking Industry
Political organizations Cannabis Store
Professional organizations Universities Credit card issuing
Social advocacy organizations Casinos and gambling Employment services Credit unions
Insurance carriers
Automobile dealers Casinos (except casino hotels) Employment Placement Agencies
Motorcycle, Boat Dealers Lotteries Executive Search Services
Other Motor Vehicle Dealers Other gambling industries

LIST OF PRIMARY BUSINESS FUNCTIONS FOR EACH INDUSTRY CONTINUED ON NEXT PAGE

RETURN TO APPLICATION
LIST OF PRIMARY BUSINESS FUNCTIONS FOR EACH INDUSTRY CONTINUED
Financial Services - Regulated Manufacturing Other Traveller accommodation Registered Charities Transportation
Monetary Authorities-Central Bank Engine equipment Manufacturing All Other Traveller Accommodation Registered Charities Charter bus services
Personal/Commercial Banking Power Transmission Equipment Mfg Bed and breakfast Passenger Transportation Service
Religious organizations
Securities/Commodity Exchanges Fertilizer Manufacturing Rail transportation
Housekeeping Cottages & Cabins
Financial Services-Unregulated Foam product Manufacturing Hunting and fishing camps Repair and maintenance Scenic, Sightseeing Transportation
Food Manufacturing Scenic/Sightseeing, Other
Miscellaneous Funds Vehicles Recreational & Vacation Camps Appliance Repair/Maintenance
Furniture/Fixtures Manufacturing School/Employee Bus Transport
Miscellaneous Financial Vehicles General Machinery Manufacturing RV Park/Campground Automotive Repair/Maintenance
Cheque Cashing Rooming and Boarding Houses Support Activity for Transport
Glass product Manufacturing Car washes
Consumer lending Hardwood Veneer/Plywood Mills Urban transit systems
Performing Artist/Sportsperson Commercial Machinery-repair/maint.
Currency Exchange House Heating Equipment Manufacturing Water transportation
Commercial Equipment-repair/maint.
Depository Credit Intermediation Refrigeration Equipment Manufacture Agents/Managers for Artists Air transportation
Industrial Machinery-repair/maint.
Financial Transactions Processing Industrial gas manufacturing Agents/Managers for Entertainer Industrial Equipment-repair/maint. Tours and Travel Services
Clearing House Activities Industrial Machinery Manufacture Agents/Managers for Public Figure Electronic Equipment-repair/maint. Other Travel Arrangement Service
Loan Arranging Jewellery/Silverware Manufacture Festivals without facilities Independent
Non-depository Cr. Intermediation Precision Equipment-repair/maint. Other travel Reservation Service
Leather goods manufacturing Actors, Comedians Independent
Sales financing Lighting fixture manufacturing Performers Footwear/Leather Goods Repair Tour operators
Securitization vehicles Lime manufacturing Independent Athletes General automotive repair Travel agencies
Machine shops Independent Visual Artist/Artisan Home/Garden Equipment Automotive
Fishing and hunting Mobile Home Manufacturing Independent Writers/Author Mechanical-repair/maint. Automotive Trucking and freight services
Fishing and hunting Material Handling Equipment Mfg Theatre Presenter with Facility Electrical-repair/maint. Personal General freight trucking
Mattress manufacturing Arts Presenter with facility Goods-repair/maint. Household Goods Specialized freight trucking
Food Services Measuring Device Manufacturing Arts Presenter W/O Facility Repair/Maintenance Reupholstery/ Used Household Goods Moving
Medical Devices Manufacturing Sports Agents and Managers Furniture Repair Used Office Goods Moving
Caterers Controlling Devices Manufacturing Sports Presenters W/O Facility
Food service contractors Medical Supplies Manufacturing Other Presenters W/O Facility Stadium Research and development Unregistered charities
Mobile food services Medical Equipment Manufacturing Presenter With Facility
Research and development Unregistered charities
Metal valve manufacturing Other Presenters With Facility
Forestry and logging Metals/Minerals Manufacturing Residential Care Services Utility services
Mining Field Machinery Manufacture Performing arts companies
Forestry and logging Utility services
Oil/Gas Field Machinery Manufacture Dance companies Child and youth case services
Fuel dealers Motor/Generator Manufacturing Musical Groups and Artists Community care facilities Emergency/ Veterinary services
Motor Vehicle Manufacturing Musical Theatre/Opera Company Other Other Relief Service Home for Veterinary services
Fuel dealers Motor Vehicle Part Manufacturing Performing Arts Company Theatre Physically Disabled
Funeral services Navigational Instruments Mfg Home for Emotionally Disturbed Virtual Currencies / MSB
(except musical) Company
Guidance Instruments Manufacturing Individual/Family Case Service Virtual Currencies / MSB
Funeral services Newsprint mills Personal care services Residential care facilities
Office Supplies Manufacturing Warehousing and storage
Gasoline stations Paint & Coating Manufacturing Barber Shops Substance Abuse Facility
Beauty Salons Service for Elderly, Disabled Transition Warehousing and storage
Gasoline stations Paper & Cardboard Manufacturing
Paper Industry Machinery Other personal Care Services homes for women Vocational Waste Management Service
Health care Pesticide Manufacturing Unisex Hair Salons Rehabilitation Service
Waste Collection Services
Agricultural Chemical Manufacturing
Ambulance/Air Ambulance Services Petrochemical manufacturing Pipeline transportation Restaurants & Drinking Places Other Waste Management Services
Community health centres Petroleum/Coal Product Manufacture Pipeline transportation Restaurants & Drinking Places Wholesale trade, Import/Export
Family planning centres Pharmaceutical/Medicine Manufacture
Retail Stores Agricultural/Farm Supply Wholesaler
General & Speciality Hospitals Plastics/Rubber Products Mfg Postal and courier services
Home health care services Poultry Manufacturing/Processing All other Merchant Wholesalers
Meat Product Manufacture/Processing Postal and courier services Misc. General Merchandise Store Beverages Merchant Wholesalers
Medical/Diagnostic Laboratories
Power Boiler Manufacturing Miscellaneous Store Retailers Beverages Merchant Wholesalers
Nursing care facilities Precious Metal Dealers Appliance, Television Stores
Offices of Doctors Heat Exchanger Manufacturing Book/Periodical/Newspaper Wholesaler
Printing ink manufacturing Jewellery Stores Other Electronics Stores Chemical/Allied Product Wholesaler
Offices of Health Practitioner
Pump/Compressor Manufacturing Audio and video stores China, Glassware Wholesaler
Rubber Industry Machinery Mfg Printing
Holding/Trust/Investment Co Automotive Parts/Accessory Store Crockery/Pottery Wholesaler
Plastics Industry Machinery Mfg Commercial Screen Printing Beer/Wine-making Supply Store Cigarette/Tobacco Prod. Wholesaler
Holding companies Sawmill Machinery Manufacturing Digital Printing Grocery and other food stores Grocery Clothing and Accessories Wholesaler
Investment Companies Woodworking Machinery Manufacturing Manifold Business Forms Printing and other food stores Camera/ Computer and Peripheral Wholesaler
Trusts Sawmills Other Printing
Ship building and repairing Photographic Supplies Store Clothing Pre-packaged Software Wholesaler
Quick Printing and Accessories Store Grocery and
Hotels Soap, Toiletries Manufacturing
Support Activities for Printing
Construction Supplies Wholesaler
Beauty Products Manufacturing other food stores Grocery and other Dairy/Milk Products Wholesaler
Casino hotels food stores Grocery and other food Electronic Component Wholesaler
Sporting/Athletic Goods Manufacture Public administration services
Hotels and motels Stamping stores Grocery and other food stores Navigational Equipment Wholesaler
Resorts Aboriginal Public Admin
Textile Mills/Cloth Manufacturing E-Shopping/Mail-order Houses Grocery Navigational Supplies Wholesaler
Tire manufacturing Correctional Services
and other food stores Furniture/Home Communications Equipment Wholesaler
Investigation/Security Service Toys and game manufacturing Courts of Law
Furnishing Store Gift, Novelty and Communications Supplies Wholesaler
Armoured car services Transportation Equipment Mfg Defence Services
Souvenir Store Grocery and other food Electronic/Home Appliance Wholesaler
Investigation services Truck trailer manufacturing Fire-fighting Services
stores Health/Personal Care Stores Floor Covering Merchant Wholesaler
Locksmiths Window and door manufacturing Foreign Affairs
Home and auto supplies stores Food/Meat/Seafood Prod. Wholesaler
Wood preservation Immigration Services
Security Guard/Patrol Service Meat and seafood markets Footwear Merchant wholesalers
Wood product manufacturing International Assistance
Security systems services Musical Instrument/Supplies Store Hardware Merchant wholesalers
Mining and drilling Labour and Employment Services
Office Supplies/Stationery Store Other Home Entertainment Equip Wholesaler
Libraries and archives Police services
Direct Selling Establishment Pet and
Mining and drilling Home Furnishings Wholesaler
Protective services
Libraries and archives pet supplies stores Pharmacies and Jewellery/Watch Wholesaler
Mobile home dealers Public administration
drug stores Live Animal Merchant Wholesaler
Manufacturing Regulatory services
Retail bakeries Lumber/Plywood/Millwork Wholesaler
Mobile home dealers
Publishing and broadcasting Sewing Goods Stores Machinery/Equip/Supply Wholesaler
Adhesive manufacturing
Agricultural Equipment Mfg
Movie/Film Production Needlework Goods Stores Mineral/Ore/Metal Wholesaler
All other information services Sporting goods stores Motor Vehicle Parts Wholesaler
All other manufacturing Motion Picture/Video Distribution Book publishers Used merchandise stores Motor Vehicle Accessory Wholesaler
Animal food manufacturing Motion Picture/Video Exhibition Directory/Mailing List Publisher
Motion Picture/Video Production Vending machine operators New/Used Automobile Wholesaler
Artificial Fibre/Filament Mfg Internet Broadcast/Websearch Portal
Other Sound Recording Industries Warehouse clubs Nursery Stock/Plant Wholesaler
Synthetic Fibre/Filament Mfg Music publishers
Post-production Picture/Video Oilseed/Grain Merchant Wholesaler
Bakery products manufacturing News syndicates Spectator sports companies Paint/Glass/Wallpaper Wholesaler
Battery manufacturing Motion Picture/Video Industry
Record production and distribution Newspaper publishers Paper/Plastic Product Wholesaler
Beverage manufacturing Spectator sports companies
Sound recording studios Other publishers Petroleum and Products Wholesaler
Boat building Pay and specialty television Taxi and Limo services Pharmaceuticals Supplies Wholesaler
Building Supplies Manufacturing Museums, zoos and nature parks Periodical publishers Pharmacy Supplies Wholesaler
Carpet and rug mills Radio broadcasting Taxi and Limo services
Chemical manufacturing Art museums and galleries Photographic Equipment Wholesaler
Historic and heritage sites Software publishers Telecommunications Photographic Supplies Wholesaler
Chocolate/Confectionery Manufacture Television broadcasting
History and science museums Poultry/Egg Merchant Wholesaler
Coating/Engraving,Allied Activity Video game publishers All other telecommunications Satellite
Nature Parks/Similar Institution Recyclable Material Wholesaler
Cold/Heat Treating,Allied Activity Other museums telecommunications
Coffee and tea manufacturing Real Estate Leasing/Broking Ser Seed merchant Wholesalers
Zoos and botanical gardens Telecommunications resellers Stationery/Office Supply Wholesaler
Commercial Industry Machinery Wired Telecommunications Carrier
Lessors of Real Estate Property Tire merchant Wholesalers
Service industry Machinery Mfg Other personal services Wireless Telecommunications Carrier
Offices of Real Estate Appraiser Toiletry/Cosmetic/Sundry Wholesaler
Communications Equipment Mfg
All other personal services Activities Related to Real Estate Testing laboratories Toy/Hobby Goods Wholesaler
Computer Product Manufacturing
Parking lots and garages Real estate agents and brokers Wholesale Trade Agent/Broker
Electronic Product Manufacturing Testing laboratories
Pet Care Services
Construction Machinery Manufacture
Translation/Interpretation Service Recreational Centres Other
Cutlery/Hand Tool Manufacturing Tobacco Related Industry
Amusement and theme parks Home Maker
Dairy products Manufacturing
Bowling centres Tobacco farming Retired
Electrical Equipment Manufacture
Fitness/Recreational Sports Centre Tobacco product manufacturing Unemployed
Electrical Appliance Manufacture
Fitness and sports centres Tobacco stemming and redrying Student
Electronics Appliances Manufacture
Golf courses and country clubs
Home Appliances Manufacture
Marinas
RETURN TO APPLICATION