Requisition Slip for exchange of Specified Bank Notes (SBN) in denominations of â¹1000 and â¹500. Name of the Bank: IC
Requisition Slip for exchange of Specified Bank Notes (SBN) in denominations of ₹1000 and ₹500 Name of the Bank: ICICI BANK LTD Branch: ____________________________
Name of Tenderer/Account Holder (In Capital Letters) ICICI Bank A/c No. (if applicable) Identity Proof (Original to be shown at the counter)
Aadhar Card, Driving License, Voter ID Card, Passport, NREGA Card, PAN Card Identity Card issued by Government Department, Public Sector Unit to its Staff.
Identification Number (Number mentioned in the identity Proof submitted) Details of Specified Bank Notes submitted for exchange
Total Value in words Signature of Tenderer/ Account Holder Contact Number Place: Date:
