Customer Request Forms – Loans Service Req. No.
:____________________________
(Deliverables, Part-payment & Closure related) Date D D M M Y Y Y Y
A. CUSTOMER DETAILS
Customer Name:___________________________________E-mail ID:_____________________________________________________________
Loan A/c No. OR Application No.
Mobile: Telephone No.
Note: Charges are applicable for services marked with *. Please visit www.icicibank.com for details on charges.
B. DELIVERABLES RELATED
List of Documents (LOD) Internal External Repayment Schedule Physical E-mail
* Copy of Property Documents * Statement of Account Physical E-mail
Copy of Sanction Letter * Prepayment Statement Physical E-mail
* Loan Agreement Conversion Disbursal (Other than Home Loan)
• Original Property Documents Reschedulement Letter
To be despatched to _____________________ Branch Reset Letter
* Prepayment Statement – Home Loan Welcome Letter / Welcome Kit
Unused PDC / SPDC Physical Scanned copy Request for Certificate for FY
• To be despatched to - Branch Communication Provisional IT Certificate Physical E-mail
Address Final IT Certificate Physical E-mail
* Duplicate NOC/NDC Interest Certificate Physical E-mail
C. PART PRE-PAYMENT OF LOAN
Amount (in Rs.): _______________________ Cash Cheque No. Bank Name______________________
EMI Change. Revised EMI (in Rs.) ______________________ Tenure Change. Revised Tenure (in Months) ________________
D. LOAN CLOSURE RELATED
Normal Maturity – Amount (in Rs.) ________________ Cash Cheque No. Bank Name ___________
*Pre-closure Amount (in Rs.) ________________ Cash Cheque No. Bank Name ___________
Repayment by (Bank Name)
Balance Transfer to__________________________________________ Own Funds Sale of Property
Internal Balance Transfer Securitized
(Provide loan account no.)
NOC / NDC Unblocking. Reason for unblocking ____________________________________________________________________________
To be despatched to - Communication Address (Branch Name)
Branch ________________________________
E. EMI RELATED
EMI Cycle Date Change. New EMI Cycle Date __________________
• Gap Interest Amount (in Rs.): _______________ Cash Cheque No. Bank Name____________________
EMI Change. Revised EMI (in Rs.) ___________________________ __________________________________
Customer Signature
For Branch Use Only
• Statement Required for / External BT Internal BT Sale of Property Pre-payment by own funds
• Conversion Pitched Yes No
• Customer Retained Yes Please specify reason
No (_____________________________________________________________________________________)
I confirm that the details match with Bank records, the applicants have signed in my presence and that I have verified the identity of
the applicant(s).
________________________________________ __________________________ Branch
Seal
Bank Official Name & Employee ID (Bank Official Signature)
Acknowledgement Slip (To be filled by Branch Official)
Service Request No.___________________________________________ Date: D D M M Y Y Y Y
Received from_________________________________________ Loan A/c No.
Request Type _______________________________________________________________________
____________________________________________ _____________________________________________ Branch
Seal
(ICICI Bank Official Name) (ICICI Bank Official Signature)
