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EXBT Form

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Date

To,
Personal Loans Division
ICICI Bank Ltd

SUB: Balance transfer of Loan / Credit Card Account No./Nos______________, ____________,


___________ with ___________________________1 (“Existing LAN / Credit Card”) to loan
account number ___________ with ICICI Bank (“ICICI LAN”).

Dear Sir/Madam,

This is with reference to the Existing LAN/Credit Card held by me, Mr/Mrs.
____________________________________, 2singly/ jointly with Mr./Ms. ___________

_______________________(“Borrower”). The details of the facilities availed by me vide


Existing LAN/Credit Card are as follows;

Sr. No. LAN No. / Credit card No. Type of Facility Outstanding Valid upto
Amount (as on
date)

I/We hereby confirm that the above details of the personal loan /credit card availed by me/us
from _____________________________________________ are true and correct.

I/ we hereby request and authorise ICICI Bank to pay the outstanding amount availed by me from
______________________ as detailed above. I/We hereby undertake to pay these outstanding
dues to ICICI Bank in accordance with terms agreed to vide credit facility application form
dated___________.

Thanking you.

Yours Faithfully,

( Customers Name and Sign)

1
Please insert the name of the bank with which existing accounts are held.
2
Delete whichever is not applicable.

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