Main Applicant ROF Bahrian 2024 copy

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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”

Ver-ICBKBAHRAOF-SAP-3.0, w.e.f. May 10, 2024

Customer type:

New

Relationship type:

Customer ID and Account (please select account type) Customer ID only

Account type:

Savings (BHD only)* Current Account (BHD only)* Call Account (select currency)

Currency:

BHD USD GBP AED Others _____________

Purpose of opening the account:

Savings Loan Against Deposit Remittance Others _____________

Mode of operation:

Relationship/ Account(s) shall be operated only by the Applicant

* Available only for Bahrain residents/ non-resident of Bahrain, travelling to Bahrain for personal of business purposes

Relationship & Account Opening Form (Single Applicant)

Relationship and Account Details

Applicant’s personal information

Male Female

Single Married

Date of birth :

Mother’s maiden name :

Mobile* :

Landline :

Fax :

E-mail :

Nationality :

Passport Number :

Place of issue :

Place of birth :

Date of issue

Date of expiry :

+ -

CPR/ National ID Number

CPR/ ID expiry date

Country of residence

If you are living in country other than country of your Nationality

(please provide VISA details)

Visa issue date

Visa expiry date

Current residential address (please mention geographical address only, PO Box is not accepted)

To be used as my 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.

+ -

City: Country:

Salutation: Mr. Mrs. Master Miss

Full Name:

(as in Passport and

please include any

aliases)

* Transaction alerts/ SMS/ OTP shall be sent on the Mobile number of Main/ First

Applicant

(Mandatory)

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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)

Employer/ Company/ Business details

Proprietorship Partnership

Private Ltd. Company Public Company

Government/ Ministry Trust/ Society

Charitable organisation Others (please specify)

Does the customer’s 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 Consultancy

Services (other than ﬁnancial) Others (please specify)

Product and services offered/ dealt in:

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

Permanent address (please mention geographical address only, PO Box is not accepted)

To be used as my communication address

City: Country:

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:

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

(e.g. Housewife, student, retired, unemployed)

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)

Same as current residential address

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Customer Declaration

Applicant’s Signature (in black ink)

Place:Date:

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,

advertising 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.

Opt Out for Postal Mail, Email, SMS, WhatsApp or any other communication for promotional or advertisement material

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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

Applicant’s Signature

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To,

ICICI Bank Limited,

Bahrain Branch

Notwithstanding anything to the contrary contained in any other document/agreement, the undersigned, hereby requests, agrees,

consents and authorises ICICI Bank Limited (the “Bank” or “you” or “your”), to act and rely on any instructions or communications for

any purpose (including but not limited to the instructions/communications pertaining to the operation of all my accounts or to any

other services/ facilities that may be provided by you to me from time to time) whether they be or purport to be given by e-mail,

telephone, facsimile, untested telexes and faxes, telegraph, cable or any other form of electronic communication by me (including such

instructions/ communications as may be or purported to be given by those authorised to operate my account(s) with the Bank)

(“Instructions”).

I understand and acknowledge that there are risks involved in sending the Instructions to you through e-mail, telephone, facsimile,

untested telexes, telegraph, cable or any other form of electronic communication and hereby agree that all risks shall be fully borne by

me assume full responsibility for the same, and you will not be liable for any losses or damages or costs or expenses arising upon your

acting, or your failure to act, wholly or in part in accordance with such instructions. I undertake to conﬁrm my telephonic instructions

by e-mail/fax immediately after having given such instructions and in any event within 24 hours, failing which the Bank shall be

entitled (but not obliged) to reverse or not to act on my telephonic instructions.

In consideration of you agreeing, subject to the terms and conditions hereunder, to act upon the above Instructions, I hereby irrevoca-

bly agree and undertake:

a. That you shall be entitled to act or refuse to act as you see ﬁt, without incurring any liability whatsoever to me or to any other

person, upon any Instructions for any purpose which may from time to time be or be purported to be given by e-mail, telephone,

facsimile, untested telexes, telegraph, cable or any other form of electronic communication by me (including such Instructions as

may be or be purported to be given by those authorised to operate my account(s) with the Bank), even if such Instructions or

communications are not followed up by written conﬁrmation to you;

b. That you are not required to verify the identity of the person giving Instructions or make any independent investigation of the

authority given to such person, or to verify the genuineness of any signature(s) which in your opinion appears to be that of any

person authorised by me to operate my account(s) with you;

c. Not to make any claim against you by reason of or on account of you having so acted or you having acted wrongly or mistakenly

or of your failure to act wholly or in part in accordance with the Instructions;

d. That you shall be entitled (but not obliged) to keep records of my Instructions given or made by e-mail, telephone, facsimile, untest-

ed telexes faxes, telegraph, cable or any other form of electronic communication in such form, physical or electronic, as you may

deem ﬁt, and your records shall be conclusive and binding on me. You shall be entitled to dispose of or destroy any such records at

any time as determined by you in accordance with your standard procedures and policies;

e. That you shall be entitled to require any Instruction in any form to be authenticated by use of any password, identiﬁcation code or

test as may be speciﬁed by you from time to time and I shall ensure the secrecy and security of such password, code or test and I

shall be solely responsible for any improper use of the same;

f. That, notwithstanding the above, you may, under circumstances determined by you in your discretion, require from me conﬁrmation

of any Instructions in such form as you may specify before acting on the same; and

g. I shall indemnify you and keep you indemniﬁed from and against all claims, either by me or any other, actions, demands, liabilities,

costs, charges, damages, losses, expenses and consequences of whatever nature (including legal fees on a full indemnity basis)

which may be brought or preferred against you or that you may suffer, incur or sustain by reason of or on account of your having

so acted whether wrongly or mistakenly or not, or of you failing to act wholly or in part in accordance with the Instructions and

terms of this letter.

h. That this letter shall be governed and construed in accordance with the laws of Kingdom of Bahrain and I hereby irrevocably submit

to the non-exclusive jurisdiction of the courts of the Kingdom of Bahrain in case of any dispute hereunder.

Indemnity relating to instructions given by Fax, e-mail, telephone and other forms of

electronic communication:

FATCA/ CRS Declaration Form

To: ICICI Bank Limited, Bahrain Branch

Customer ID : Primary 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)

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

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

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-ICBKBAHRAOF-SAP-3.0, 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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To be ﬁlled by Bahrain operations team.

I have met Mr./Ms. _____________________________________________, on ___________________ at ______________________ in person

and hereby conﬁrm the identity ﬁlled in the relationship form in my presence. I have veriﬁed the information ﬁlled in with the

original documents and certify that they convey compliance with bank’s KYC guidelines.

I have met Mr./Ms. _____________________________________________, on ___________________ at ______________________and offered

him/her the above-mentioned products and services when he/she was in _____________________________________(name of the

country outside the present country of residence). I conﬁrm that I have not solicited the client in his country of residence in respect of

any product that is not permitted in that country.

Mode of Contact (please tick as applicable)

Branch visitor/Walk-in Customer

Meeting outside when the customer was in _______________________________ (place/ country of residence).

Non - Face to Face

Checked and veriﬁed by RM/Bank ofﬁcial

For Bahrain resident customers

For customers not resident in Bahrain

.oN tnuoccA DI remotsuC

Name :

Employee No. :

RM Code :

Signature :

Date :

RM/Bank ofﬁcial conﬁrmation

(to be ﬁlled in by the bank)

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Please afﬁx Welcome Kit acknowledgement received from the customer

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Documents required for commencing a relationship

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):

• 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 ROF)

• Ofﬁcial document card such as CPR, from a public/government authority

• Tenancy agreement (expiring not less than 15 days from the date as mentioned in the ROF)

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):

• 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 ROF)

• Ofﬁcial document card such as CPR, from a public/government authority

• Tenancy agreement (expiring not less than 15 days from the date as mentioned in the ROF)

For persons living outside Bahrain

A. 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):

• 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 ROF)

• Ofﬁcial document card such as CPR, from a public/government authority

• Tenancy agreement (expiring not less than 15 days from the date as mentioned in the ROF)

B. Sending the forms by post/courier

1. Valid Passport

2. Valid Resident identity card with a clear photograph

Address proof (any one of the following):

• 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 ROF)

• Ofﬁcial document card such as CPR, from a public/government authority

• Tenancy agreement (expiring not less than 15 days from the date as mentioned in the ROF)

Any document copied for the purpose of identiﬁcation veriﬁcation must be 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 individual making the certiﬁcation must give clear contact details (e.g. by attaching a business card or company

stamp).

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