ICICI Bank Canada

Referral form for Credit Card/Account Services
Please provide the correct details asked in form below in order to avoid any future inconvenience. (* marked fields are mandatory). To learn more about Royal Bank of Canada products & services in association with ICICI Bank Canada, please complete the form below:


I want to apply for both Chequing Account & Credit Card I want to apply only for Credit Card

*First Name
*Last Name
*Date of Birth Age should be greater than 18
RBC Chequing Account Number (If available) RBC Chequing Account Number should be numeric and length less than 16

Enter your Address Details:
*Postal Code Postal code format should be like A1B2C3
*Phone
*Email Address

CONSENT FOR ELECTRONIC COMMUNICATION
ICICI Bank Canada is required to obtain your consent to send you electronic communications about our product offers and promotions. Please confirm that ICICI Bank Canada may send you these electronic messages. You can withdraw your consent at any time.
 Yes, I wish to receive electronic messages from ICICI Bank Canada regarding its promotional offers and services at the e-mail address provided to ICICI Bank Canada.
 No, thanks.

CONSENT TO SHARE INFORMATION WITH PARTNER
With your consent, ICICI Bank Canada will share with Royal Bank of Canada (RBC) the information you provided on this form in order to administer the referral arrangement between ICICI Bank Canada and RBC. Personal information that is shared with RBC will not be used for any other purpose, unless otherwise required by law.

  I consent to the sharing of my personal information as set out above.

General Consent
I, have read and understand the Consent and the General Terms for electronic delivery, and consent to electronic delivery of the following ICICI Bank account-related documents ("Documents"):
(a) Monthly e-statements for individual Bank Accounts
(b) Tax Documents (including T5, NR4, T4RSP, RL-2, RL-3 and RRSP Contribution Slips);
(c) Notice of changes to any agreement which governs my Account(s) or a related service;
(d) Notice of changes to any interest rate or fee, new fees and any other information regarding my Account or a related service;
(e) Information relating to the renewal of my Bank Account;
(f) Documents relating to my Investment Accounts such as GIC certificates;
(g) Disclosure statement of fees and charges for Personal Accounts; and
(h) Any other communication, notice or information that is required by the terms and conditions of ICICI Bank, by law, or otherwise to be provided to me in writing about my Account; and
  I confirm and provide this Consent.
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