Customer type:
Main applicant Joint applicant * Customer ID:
* In case form is filled by Joint applicant, please specify the relationship with the Main applicant _________________________________
Re-KYC Form (Primary applicant/ Joint applicant)
Applicant’s personal information
Current residential address
To be used as my mailing/ communication address
Permanent address
Permanent contact number:
To be used as my mailing/ communication address
1. Please ensure that all fields are filled and no field is left blank (please strike off or mark N/A if not applicable). Any overwriting/change in the form
must be authenticated by the applicant’s signature beside it, else the form will be rejected.
2. For , please tick (√) where appropriate. Do not use (x) or any other mark.
3. Please fill separate form for each Joint applicant
Page 1 of 8
City:
Country:
City:
Country:
ICICI Bank Limited,
P. O. Box 1494, Manama,
Kingdom of Bahrain
“Licensed and regulated as a conventional retail bank by the Central Bank of Bahrain”
As per enclosed CPR/ National ID/ Driving Licence copy
As per enclosed Passport copy
Others (please provide the document & address below)
Ver-ICBKBAH-2018KYC-4.0, w.e.f. May 10, 2024
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1
3
2
5
As per enclosed CPR/ National ID/ Driving Licence copy
As per enclosed Passport copy
Others (please provide the document & address below)
Mobile * :
Landline : Fax :
E-mail :
Transaction alerts/ SMS/ OTP shall be sent on the Mobile number of Main/ First Applicant
*
I confirm submitting below listed documents. Kindly update my bank records with details mention in these documents.
1. Valid CPR/ National ID issued by my Residing Country
2. Valid Passport Copy
3. Valid visa copy issued by my Residing Country Not applicable, as my Residing Country and
Nationality are same
Maritial Status: Married Single
Full Name:
(as in Passport and please include any aliases)
Salutation: Mr. Mrs. Master Miss
Employer details
Activation of dormant account(s)
Special customer category:
Orphan Widow Pensioner
Student
Bahraini national/ resident earning less
than BD 250 per month
Person receiving social subsidy from Ministry of Social
Development
Employed Self-employed
Others (please specify) ______________________
Occupation:
Personal monthly gross salary or income or profit from
business/ profession
BHD USD
Expected total value/ volume of annual credits in account
BHD USD
Permanent account number (PAN) declaration:
Whether Permanent account number (PAN) issued by Indian
taxation authorities in my name / name of the entity or in the
name of any branch or any other office located in India
Yes No
If Yes, PAN number:
(e.g. Housewife, student, retired, unemployed)
As per enclosed CPR/ national ID copy Others (please provide the document)
Employer Name :
Employer address :
To be used as my mailing/ communication address (please provide the proof/ letter from employer)
Number of years in present business/ with employer: < 1 Year > 1 year: _______________ (No. of years)
City : Country :
I/ We confirm that I/we have not operated my/our account(s) for
the following reason
I/We request you to activate my/our below account(s)
6
7 8
11
9
10
Employer/ Company/ Business details
Proprietorship Partnership
Private Ltd. Company Public Company
Government/ Ministry Trust/ Society
Charitable organisation Others (please specify)
Does the customers business/activity involve any of these
businesses? Please specify
Cash intensive business (Restaurant/Convenience store)
Agent/Broker/Jewelry dealer Real estate
Money changer/remitter Building & Construction
Manufacturing Commerce
Financial Institution/ Bank Consultancy
Services (other than financial) Others (please specify)
Major source of income/ wealth/ funding the account:
Income from business Salary
Gift received Rental
Retirement/ Pension Benefits Inheritance
Investments (non-business)
Others (please specify)
Product and services offered/ dealt in:
a)
b)
c)
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Ver-ICBKBAH-2018KYC-4.0, w.e.f. May 10, 2024
Customer Declaration
For Non-Residents of Bahrain only
I hereby declare that call account will be used only for transactions with regard to loan availed from ICICI Bank Limited, Bahrain
Branch (the “Bank”)/ Remittance to India/ Insurance linked investments or other products/ services approved by the bank.
For both Residents and Non-Residents of Bahrain
I am acting and would, in future will also be acting on my behalf for the purpose of transaction, new accounts or providing
furtherinformation required by ICICI Bank Limited, Bahrain Branch. I also declare the relationship/account with the Bank is for
the placement of my income/ funds received from source of funds as mentioned in this form.
I confirm that I have read and understood the General Terms & Conditions Governing Account(s) as well as terms and conditions
relevant to the products being availed by me (“Terms and Conditions”) of ICICI Bank Limited, Bahrain Branch (the “Bank”)
available on www.icicibank.bh. I also agree to be bound by the Terms and Conditions, including as may be amended from time
to time on the website, for my relationship with the Bank. I hereby specifically agree and confirm that the Bank shall be entitled
to disclose and/or procure information pertaining to me as provided in the Terms and Conditions.
I DO NOT AGREE to receive from ICICI Bank Limited, Bahrain Branch (the “Bank”) or my relationship manager, marketing, adver-
tising and promotional information, materials and/or documents relating to products and/or services (including products and/or
services of third party merchants whom the Bank and/ or ICICI Entities may collaborate or tie up with) via postal mail and/ or
electronic transmission to my registered email address(es)/ mobile(s).
Please indicate your non-agreement by inserting a [√] in the box to the left. If you do not insert a tick in the said box, it means
the Bank (including your designated relationship manager) will be able to send you marketing, advertising and promotional
information, materials and/or documents.
Applicant’s Signature (in black ink)
Place:Date:
Checked and verified by RM/Bank official
Name :
Employee No. :
RM Code :
Signature :
Date :
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Opt Out for Postal Mail, Email, SMS, WhatsApp or any other communication for promotional or advertisement material
FATCA/ CRS Declaration Form
To: ICICI Bank Limited, Bahrain Branch
Customer ID : Primary Applicant Joint Applicant
Full Name:
(as in Passport and please include any aliases)
Salutation: Mr. Mrs. Master Miss
Please indicate the tax residency in the below table. If resident in
more than one country, please provide all countries and associated
tax identification numbers. (If the Account Holder is tax resident in
more than three countries / jurisdictions, please use a separate sheet)
I/We hereby confirm the information provided above is true, accurate and complete.
Subject to applicable local laws, I/we hereby consent for the bank or any of its affiliates (including branches) (collectively “the Bank”) to share
our information with domestic or overseas regulators or tax authorities where necessary to establish our tax liability in any jurisdiction.
I/We agree and undertake to notify the Bank within 30 calendar days if there is a change in any information which I/we have provided to the
Bank.
Country of Tax Residence
TIN/
Functional Equivalent (FE)
If a TIN is unavailable please provide the appropriate reason A, B or
C where indicated below: (Provide if TIN not available for any of the
aforementioned countries).
A. The country/jurisdiction where the Account Holder is
resident does not issue TINs to its residents.
B. The Account Holder is otherwise unable to obtain a TIN or
equivalent number.
_________________________________________________________
(Please explain)
C. No TIN is required. (Only select this reason if the domestic
law of the relevant jurisdiction does not require the collection
of the TIN issued by such jurisdiction)
1.
2.
3.
Please answer ALL the below Questions Yes No Requirements if the answer is ‘Yes
1a) Are you a US citizen? W-9
1b) Are you a US tax resident (e.g. Green Card Holder)?
Please tick (√)
2) Were you born in the US?
W-9
W-9
you are a US citizen
Renunciation of US
citizenship issued by US
Government + W-8BEN
you are not a US
Citizen
Non-US Person US Person TIN:
Declaration and Signature
Name : _____________________________________________________________________________
ID Number :
Signature : _____________________________________
Date :
BM/ BOM/ Bank official Authorization
Name: .....................................................................................................
SIGNATURE OF Authorising Official
Employee ID: ..........................................................................................
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Note: For purposes of this Self Certification, tax resident in the United States includes US persons. US person is defined as a US citizen or resident individual, a
partnership or corporation organised in the US or under the laws of the US or any State thereof, a trust if (i) a court within the US would have authority under
applicable law to render orders or judgments concerning substantially all issues regarding administration of the trust, and (ii) one or more US persons have the
authority to control all substantial decisions of the trust, or an estate of a decedent that is a citizen or resident of the US.
Date of Birth :
Nationality :
Place of Birth :
Residential Country :
____________________________________
____________________________________
____________________________________
Bahrain Personal Data Protection Law - Privacy Policy
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Ver-ICBKBAH-2018KYC-4.0, w.e.f. May 10, 2024
About ICICI Bank:
ICICI Bank Limited, Bahrain Branch (“Bahrain Branch”) (‘ICICI’ or the ‘Bank’) is an overseas branch of ICICI Bank Limited, India - a comprehensive
financial services provider and one of the largest players in the Indian Financial Services industry. ICICI Bank, having achieved leadership in the
domestic market, has now established a presence in the major global financial Centers including USA, Canada, UK, UAE, Bahrain, China, and
Singapore. ICICI Bank Bahrain has been granted Retail Bank (Branch) License during May 2007 by Central Bank of Bahrain (the Regulator) for
Retail and Full Commercial Banking Activities in the Kingdom of Bahrain. Such a license entitles the branch to act as hub for business in the Middle
East and to deal with Resident and Non-Residents of Bahrain in any currency. ICICI Bank, Bahrain Branch offers its clients a wide range of customer
friendly products like Bank accounts, Deposits, Loan Against Deposits, Remittance facilities through branch/ online/ Kiosk and attractive investment
options.
For the purpose of processing the above-mentioned services, ICICI collects, processes, and retains the required personal data and sensitive person-
al data of its prospects, customers and third parties. Furthermore, to engage employees / contractors for providing these services, ICICI collects,
processes and retains job candidates and employees personal data.
Origin of Personal Data & Sensitive Personal Data:
ICICI collects the prospects personal and sensitive data for sharing products and service details. The Bank also collects customers personal data
directly through opening new customers accounts and during performing the core sales and distribution operations.
Categories of Personal Data:
ICICI processes the prospects and customers following personal data: Identity and Contact details such as Full name, postal addresses, email
address, phone numbers, customer account established in ICICI, CPR copy, smart card data etc.
Purposes for Data Collection and Lawful Basis for Processing:
ICICI only processes your personal data based on one or more of following lawful basis under Bahrain Personal Data Protection Law (’Bahrain
PDPL’):
Categories of Recipients of your Data:
Your personal data will be processed by ICICI and may be shared with third parties within or outside the Kingdom of Bahrain including cloud provid-
ers for email communication and online and Disaster Recovery storage, when required by the law, or where it is necessary to administer the
relationship with you or where we have one of the above-mentioned legitimate interests in doing so. This includes sharing your personal data with
banks, auditors, system support vendors, and governmental bodies, with any other parties as detailed in respective product(s) or service(s) related
forms and general terms and conditions applicable for availing such service(s) or product(s) from ICICI.
Your rights under Bahrain PDPL (Act No. 30 of 2018)
You have the rights to submit your request free of charge to ICICI:
a. To be notified about the complete data concerning you and request its rectification.
b. Remove, block, or restrict your personal data.
c. Object if your personal data is being used for direct marketing.
d. Object if processing may result in defamation or discrimination causing possible financial or moral damage.
e. Object if your personal data is being used for decisions based on automated data processing and request that the processing be solely
automated.
Purpose Lawful Basis
To open new accounts to potential customers Contractual Obligation
To acknowledge collections from customers from all locations Contractual Obligation
To offer credit to the customers Contractual Obligation
Legitimate Interest
To apply online backups, system support and maintenance activities Legal Obligation
Legitimate Interest
To provide your information to auditors during and after your contract to verify compliance with Bahrain
Laws
Legal Obligation
To store your contact details electronically in our records for communication Legitimate Interest
Data Subject Consent
To comply with ICICI’s internal policies and procedures Contractual Obligations
Legitimate Interests
Purposes relating to any of the above Legal Obligation
Legitimate Interests
Contractual Obligations
Any other purposes as detailed in respective product(s) or service(s) related forms and general terms and
conditions as agreed
Legal Obligation
Legitimate Interests
Contractual Obligations
Any other purposes permitted by law Legal Obligation
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Ver-ICBKBAH-2018KYC-4.0, w.e.f. May 10, 2024
f. Withdraw your consent to the processing of your personal data in cases where you have provided your consent for the processing and, as such,
your consent is the lawful basis that ICICI is relying on for processing.
ICICI shall process such request free of any charges within a period of 10 working days, otherwise as stipulated by the law.
A consent once given by the prospect and/or customer can be withdrawn at any time for any future actions.
You have the right to lodge a complaint to Bahrain Personal Data Protection Authority (Bahrain PDPA) regarding any violation of Bahrain
PDPL and its implementing Orders.
Decisions based on automated processing
ICICI will not take decisions for additional processing beyond the purpose of the collected personal sensitive data based on automated processing
(i.e., loans and remittances) of your personal data and may inform you in case this condition is changed.
Security of your Personal Data
Prospects and customers’ personal data is protected under Bahrain PDPL and ICICI ensures implementing selective security measures for protect-
ing your privacy. ICICI shall implement technical and organisational security measures to keep your personal data secured and protected including
when cross border transfer and storage.
Retention Period of your Personal Data
The personal data collected by ICICI is retained for as long as necessary to fulfil the purpose for which it was collected, and/or based on the validity
of the contract, legal retention period requirements, and historical archiving. We securely destroy and erase or anonymize your personal data to
ensure that it cannot be restored after exceeding the retention criteria. Hence, ICICI will not be able to support you with any further processing or
information request on your personal data.
Contact details
If you have any questions or would like to obtain more details about how we use your personal data, you may contact ICICI at
[email protected], or write to ICICI Bank Limited, P.O. Box 1494, Manama, Kingdom of Bahrain.
Your Role to Keep your Personal Data Accurate
It is essential for ICICI to keep your personal data up to date and accurate. Therefore, kindly provide your updated information in case there is any
change to your personal data during your business relationship with us.
Update on Privacy Policy
ICICI has the right to review and update the privacy policy. In case of any changes, we will inform you of any substantial change in how we process
your personal data which will be updated on ICICI Bank’s website www.icicibank.bh. ICICI reserves the right to alter, delete, modify or add any of
the aforesaid terms, and such alterations, deletions or additions shall be deemed to be effective and binding on me/us.
Customer Declaration - Bahrain PDPL
Processing and sharing my/our personal data for the purposes stated in this privacy policy. (Please tick)
Collecting information through other sources for processing and evaluating my application and managing the contractual relationship.
(Please tick)
I/We hereby acknowledge that I/we have read and fully understood the privacy policy and I/we consent to have ICICI:
Applicant’s Signature
Applicant’s Name
Date
In case the prospect and/or customer does not provide any of the above-mentioned personal data, ICICI will not be able to perform further
processing and comply with the legal and/or contractual requirements. Please note: You have the right to withdraw your consent at any time by
contacting our DPG as long as withdrawal will not stop us from performing our legal and contractual obligations.
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Ver-ICBKBAH-2018KYC-4.0, w.e.f. May 10, 2024
I, the undersigned, hereby understand that “Wathiq” is an Electronic Know-Your-Client (eKYC) platform developed by The BENEFIT
Company (BENEFIT) designed to digitally authenticate, receive, and verify my identity and information from the Information &
eGovernment Authority (IGA) and others (CBB licensees) periodically to ICICI Bank Ltd., Bahrain Branch.
I agree that “Wathiq” will collect the following information as per CBB requirements when I request a financial service from ICICI Bank
Ltd., Bahrain Branch:
1. Personal and ID Information
2. Contact Information
3. Account Details
4. Employment Details
5. Residency Information
I am aware that my information will be retained by ICICI Bank Ltd., Bahrain Branch for 10 years and might be shared with third parties
within and outside Bahrain for the purposes of regulatory requirement, cloud storage, statistics, and other reasons in line with applica-
ble laws and regulations.
I have the right at any time to withdraw the consent provided. I understand that withdrawal of consent will be applicable to future use
of the personal data and will not in any way impact legitimate use of the personal information prior to the withdrawal of the consent.
For more details, please refer to the privacy policy available on https://www.benefit.bh/privacypolicy/
I confirm with my full legal capacity that I have read the above and understood the purposes in which ICICI Bank Ltd., Bahrain Branch
collects and retains my information and provide consent to “Wathiq” to process and transfer this information for eKYC purposes.
Wathiq (eKYC Consent)
CLIENT
WITNESS
Applicant’s Signature
Applicant’s Name
Applicant’s CPR Number
Date
Witness Signature
Witness Name
Witness CPR Number
Date
Documents required for ongoing KYC:
For Bahraini nationals
Photocopies of the following:
Identity proof (any one of the following):
Valid passport and valid CPR card with a clear photograph
Valid CPR or Valid ID card with a clear photograph
Address proof (any one of the following):
Official document card such as CPR from a public/government authority
Recent utility bill (Electricity/Telephone bills not more than 3 months old from the date as mentioned in the ROF)
Bank statement (not more than 3 months old from the date as mentioned in the Re-KYC form)
Tenancy agreement (expiring not less than 15 days from the date as mentioned in the Re-KYC form)
* In case customer is opting employment address as mailing/ communication address, adequate proof shall be provided from public database (e.g.
commercial registration, trade license, annual report) or a letter from employer.
For residents of Bahrain (other than Bahraini nationals)
Photocopies of the following:
Identity proof (both required):
Valid passport and valid visa
Valid CPR card or Valid ID card with a clear photograph
Address proof (any one of the following):
Official document card such as CPR, from a public/government authority
Recent utility bill (Electricity/Telephone bills not more than 3 months old from the date as mentioned in the Re-KYC form)
Bank statement (not more than 3 months old from the date as mentioned in the Re-KYC form)
Tenancy agreement (expiring not less than 15 days from the date as mentioned in the Re-KYC form)
* In case customer is opting employment address as mailing/ communication address, adequate proof shall be provided from public database (e.g.
commercial registration, trade license, annual report) or a letter from employer.
For persons living outside Bahrain
Visiting the Bahrain branch or meeting a Bahrain branch official or meeting an official of ICICI Bank, India or its branches/subsidiar-ies/representative
offices overseas/correspondent banks.
Identity proof (both required):
Valid Passport
Valid resident identity card with a clear photograph
Address proof (any one of the following):
Official document card such as CPR, from a public/government authority
Recent utility bill (Electricity/Telephone bills not more than 3 months old from the date as mentioned in the Re-KYC form)
Bank statement (not more than 3 months old from the date as mentioned in the Re-KYC form)
Tenancy agreement (expiring not less than 15 days from the date as mentioned in the Re-KYC form)
* In case customer is opting employment address as mailing/ communication address, adequate proof shall be provided from public database (e.g.
commercial registration, trade license, annual report) or a letter from employer.
Sending the forms by post/courier-
Valid Passport
Valid Resident identity card with a clear photograph
Address proof (any one of the following):
Official document card such as CPR, from a public/government authority
Recent utility bill (Electricity/Telephone bills not more than 3 months old from the date as mentioned in the Re-KYC form)
Bank statement (not more than 3 months old from the date as mentioned in the Re-KYC form)
Tenancy agreement (expiring not less than 15 days from the date as mentioned in the Re-KYC form)
* In case customer is opting employment address as mailing/ communication address, adequate proof shall be provided from public database (e.g.
commercial registration, trade license, annual report) or a letter from employer.
Any document copied for the purpose of identification verification must be self-attested and certified by:
an official of a government ministry; or
an official of an embassy or consulate; or
an official of another licensed financial institution or of an associate company of the licensee of a GCC member state or FATF member state. The individu-
al making the certification must give clear contact details (e.g. by attaching a business card or company stamp).
In certain cases, your Relationship Manager may contact you for additional documents evidencing proof of source of income and wealth.
Deposits held with ICICI Bank Limited, Bahrain branch in the Kingdom of Bahrain are covered by the Regulation Protecting Deposits and Unrestricted
Investment Accounts issued by the Central Bank of Bahrain in accordance with Resolution No. (34) of 2010.
a)
b)
a)
b)
c)
d)
a)
b)
a)
b)
c)
d)
1.
a)
b)
a)
b)
c)
d)
2.
a)
b)
a)
b)
c)
d)
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