And D: Consent Eclaration Form For Aadhaar Based Authentication/Verification

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Consent and Declaration Form for Aadhaar Based Authentication/Verification

APPLICATION NO:

I/We have been provided various options by the Bank for establishing my/our identity/address
proof for opening the bank account and have voluntarily submitted my Aadhaar to ICICI Bank
(“Bank”) and hereby give my/ our consent to the Bank:- (i) to establish my/our identity / address
proof by Aadhaar based authentication system or verify the genuineness of the Aadhaar
through Quick Response (QR) code or through such other manner as set out by UIDAI or any
other law from time to time; (ii) share my/our Aadhaar detail with UIDAI, NPCI, concerned
regulatory or statutory authorities as any be required under applicable laws.

I/We hereby agree with the below terms pertaining to Aadhaar based authentication/
verification:

1. I/We have been informed that: (a) upon authentication, UIDAI may share with ICICI Bank
information in nature of my /our demographic information including photograph which ICICI
Bank may use as an identity/address proof for the purpose of account opening;(b) my/our
Aadhaar details (including my demographic information) shared by UIDAI will not be used for
any purpose other than the purpose mentioned above or as per requirements of law; (c) my/our
biometric information will not be stored by the Bank.
2. I/We agree that the consent and purpose of collecting Aadhaar has been explained to me/us
in local language.

____________________________________________________________________________

(Signature/Thumb Impression of Individual/Proprietor / Partner / Authorised Signatory /


Beneficial Owner)

Name of account holder: Date :

___________________________________

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