Customer Name Card Account No

MR CHANDRASHEKAR K 4375 XXXX XXXX 6003

UJJIVAN SMALL FINANCE BANK LTD
3177 3052 SRI COMPLEX 15TH CROSS RP ROAD
NANJANGUD
BELOW BAJAJ FINANCE LIMITED
MYSORE 571301

Statement Period

01/04/2020 TO 31/03/2021

TRANSACTION DETAILS
Card Number : 0000 XXXX XXXX 9865
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
05-NOV-20 Ex-Gratia Payment 0.00 -19.89

TRANSACTION DETAILS
Card Number : 4375 XXXX XXXX 6003
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
02-APR-20 600302042020S16192431 NEFT PAYMENT RECEIVED 0.00 -4,378.00

05-APR-20 IGST-CI@18% 0.00 8.44

05-APR-20 Interest Amount Amortization - 0.00 46.91

<6/6>FLIPKART PAYMENTS

05-APR-20 Principal Amount Amortization - <6/6> 0.00 4,330.54

FLIPKART PAYMENTS

28-APR-20 74332740120011900992824 MAHAVEER MEDICALS NANJANGUD IN 0.00 1,100.00

30-APR-20 74056630122012142592575 Flipkart Payments BANGALORE IN 0.00 1,699.00

07-MAY-20 600307052020S49878289 NEFT PAYMENT RECEIVED 0.00 -200.00

28-MAY-20 600328052020S31488764 NEFT PAYMENT RECEIVED 0.00 -2,722.00

05-JUN-20 74056630158015787183243 Flipkart Payments BANGALORE IN 0.00 1,199.00

16-JUN-20 74766510168023354375500 MANJULA FUEL SERVICE S MYSORE IN 0.00 341.56

26-JUN-20 600326062020S71746954 NEFT PAYMENT RECEIVED 0.00 -1,540.00

27-JUN-20 74585300180000135979080 S V INFOWAYS MYSORE IN 0.00 60,000.00

30-JUN-20 S V INFOWAYS MYSORE IN 0.00 -60,000.00

30-JUN-20 INSTANT EMI OFFUS CONVERSION 0.00 0.00

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
 TRANSACTION DETAILS
Card Number : 4375 XXXX XXXX 6003
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
30-JUN-20 IGST-CI@18% 0.00 125.91

30-JUN-20 Interest Amount Amortization - <1/9> 0.00 699.50

30-JUN-20 Principal Amount Amortization - <1/9> 0.00 6,361.78

07-JUL-20 600307072020S49974674 NEFT PAYMENT RECEIVED 0.00 -7,200.00

30-JUL-20 IGST-CI@18% 0.00 112.56

30-JUL-20 Principal Amount Amortization - <2/9> 0.00 6,435.95

30-JUL-20 Interest Amount Amortization - <2/9> 0.00 625.33

05-AUG-20 600305082020S11142567 NEFT PAYMENT RECEIVED 0.00 -7,174.00

30-AUG-20 Principal Amount Amortization - <3/9> 0.00 6,510.98

30-AUG-20 IGST-CI@18% 0.00 99.05

30-AUG-20 Interest Amount Amortization - <3/9> 0.00 550.30

05-SEP-20 600305092020S36181883 NEFT PAYMENT RECEIVED 0.00 -7,200.00

30-SEP-20 IGST-CI@18% 0.00 85.39

30-SEP-20 Principal Amount Amortization - <4/9> 0.00 6,586.89

30-SEP-20 Interest Amount Amortization - <4/9> 0.00 474.39

05-OCT-20 600305102020S64554079 NEFT PAYMENT RECEIVED 0.00 -7,200.00

23-OCT-20 74332740298029750767167 MOBILE WORLD NANJANGUD IN 0.00 19,890.00

29-OCT-20 IGST-CI@18% 0.00 47.74

29-OCT-20 IGST-CI@18% 0.00 71.60

29-OCT-20 MOBILE WORLD NANJANGUD IN 0.00 397.80

29-OCT-20 MOBILE WORLD NANJANGUD IN 0.00 -19,890.00

29-OCT-20 Interest Amount Amortization - 0.00 265.20

<1/6>MOBILE WORLD

29-OCT-20 Principal Amount Amortization - 0.00 3,206.21

<1/6>MOBILE WORLD

30-OCT-20 Principal Amount Amortization - <5/9> 0.00 6,663.68

30-OCT-20 IGST-CI@18% 0.00 71.57

30-OCT-20 Interest Amount Amortization - <5/9> 0.00 397.60

02-NOV-20 600302112020S82063604 NEFT PAYMENT RECEIVED 0.00 -10,500.00

29-NOV-20 Interest Amount Amortization - 0.00 222.45

<2/6>MOBILE WORLD

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
 TRANSACTION DETAILS
Card Number : 4375 XXXX XXXX 6003
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
29-NOV-20 IGST-CI@18% 0.00 40.04

29-NOV-20 Principal Amount Amortization - 0.00 3,248.96

<2/6>MOBILE WORLD

30-NOV-20 IGST-CI@18% 0.00 57.58

30-NOV-20 Interest Amount Amortization - <6/9> 0.00 319.91

30-NOV-20 Principal Amount Amortization - <6/9> 0.00 6,741.37

05-DEC-20 600305122020S60631176 NEFT PAYMENT RECEIVED 0.00 -10,500.00

20-DEC-20 74766510355050056872206 MANJULA FUEL SERVICE S MYSORE IN 0.00 411.80

25-DEC-20 74766510361051352929452 HPCL VASUKI FUELS MYSORE IN 0.00 304.91

27-DEC-20 HPCL Surcharge Rev 0.00 -10.00

27-DEC-20 IGST-Rev-CI@18% 0.00 -1.80

29-DEC-20 Interest Amount Amortization - 0.00 179.13

<3/6>MOBILE WORLD

29-DEC-20 IGST-CI@18% 0.00 32.24

29-DEC-20 Principal Amount Amortization - 0.00 3,292.28

<3/6>MOBILE WORLD

30-DEC-20 Interest Amount Amortization - <7/9> 0.00 241.32

30-DEC-20 Principal Amount Amortization - <7/9> 0.00 6,819.96

30-DEC-20 IGST-CI@18% 0.00 43.44

02-JAN-21 600302012021S22749809 NEFT PAYMENT RECEIVED 0.00 -11,000.00

04-JAN-21 74332741006100403426740 RELIANCE BP MOBILITY L 0.00 202.00

CHAMARAJANAGA IN

11-JAN-21 74053411012001856459429 AshirwadServiceStation Mysore IN 0.00 354.13

15-JAN-21 74585191016030546487418 SRI SRIKANTESHWARA T V MYSORE IN 0.00 24,000.00

22-JAN-21 Principal Amount Amortization - <1/6>SRI 0.00 3,868.73

SRIKANTESHWARA T V

22-JAN-21 SRI SRIKANTESHWARA T V MYSORE IN 0.00 -24,000.00

22-JAN-21 SRI SRIKANTESHWARA T V MYSORE IN 0.00 480.00

22-JAN-21 Interest Amount Amortization - <1/6>SRI 0.00 320.00

SRIKANTESHWARA T V

22-JAN-21 IGST-CI@18% 0.00 57.60

22-JAN-21 IGST-CI@18% 0.00 86.40

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
 TRANSACTION DETAILS
Card Number : 4375 XXXX XXXX 6003
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
29-JAN-21 Interest Amount Amortization - 0.00 135.23
<4/6>MOBILE WORLD

29-JAN-21 IGST-CI@18% 0.00 24.34

29-JAN-21 Principal Amount Amortization - 0.00 3,336.18

<4/6>MOBILE WORLD

30-JAN-21 Principal Amount Amortization - <8/9> 0.00 6,899.47

30-JAN-21 Interest Amount Amortization - <8/9> 0.00 161.81

30-JAN-21 600330012021S87698220 NEFT PAYMENT RECEIVED 0.00 -1,000.00

31-JAN-21 IGST-CI@18% 0.00 29.13

08-FEB-21 600308022021S79769225 NEFT PAYMENT RECEIVED 0.00 -10,000.00

09-FEB-21 600309022021S96010444 NEFT PAYMENT RECEIVED 0.00 -5,000.00

10-FEB-21 600310022021S25452630 NEFT PAYMENT RECEIVED 0.00 -900.00

22-FEB-21 Principal Amount Amortization - <2/6>SRI 0.00 3,920.31

SRIKANTESHWARA T V

22-FEB-21 Interest Amount Amortization - <2/6>SRI 0.00 268.42

SRIKANTESHWARA T V

22-FEB-21 IGST-CI@18% 0.00 48.32

28-FEB-21 Interest Amount Amortization - <9/9> 0.00 81.38

28-FEB-21 Principal Amount Amortization - <9/9> 0.00 6,979.92

28-FEB-21 IGST-CI@18% 0.00 14.65

28-FEB-21 Principal Amount Amortization - 0.00 3,380.66

<5/6>MOBILE WORLD

28-FEB-21 IGST-CI@18% 0.00 16.34

28-FEB-21 Interest Amount Amortization - 0.00 90.75

<5/6>MOBILE WORLD

03-MAR-21 600303032021S34175687 NEFT PAYMENT RECEIVED 0.00 -14,795.00

11-MAR-21 74766511070109819217562 MANJULA FUEL SERVICE S MYSORE IN 0.00 402.11

13-MAR-21 74332741073107263417493 APOLLO PHARMACY NANJANGUD IN 0.00 308.00

22-MAR-21 Principal Amount Amortization - <3/6>SRI 0.00 3,972.58

SRIKANTESHWARA T V

22-MAR-21 IGST-CI@18% 0.00 38.91

22-MAR-21 Interest Amount Amortization - <3/6>SRI 0.00 216.15

SRIKANTESHWARA T V

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
 TRANSACTION DETAILS
Card Number : 4375 XXXX XXXX 6003
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
29-MAR-21 Interest Amount Amortization - 0.00 45.68
<6/6>MOBILE WORLD

29-MAR-21 Principal Amount Amortization - 0.00 3,425.71

<6/6>MOBILE WORLD

29-MAR-21 IGST-CI@18% 0.00 8.22

For ICICI Bank Limited.

Sudipta Roy
Head – Consumer Cards

Important Messages
Safe Banking Tips - Do not transact if you find any suspicious device attached to the ATM. Do not take help
from strangers at an ATM.

ICICI Bank Credit Cards Goods and Services Tax Identification Number (GSTIN) is 27AAACI1195H3ZK

HSN Code for service: 9971 - Financial and related services

Our registered office address : ICICI Bank Tower, Bandra Kurla Complex, MUMBAI, Mumbai Suburban,
Maharashtra - 400051

Making only minimum payment every month can lead to repayment stretching over years with consequent
interest payment on outstanding balance

Please pay your credit card outstanding before the payment due date to avoid penal fees and interest
charges.

For payments made through cheque, we request you to make the payment atleast 3 working days before the
due date incase of an ICICI Bank cheque and 5 working days before the due date for Non-ICICI Bank cheques.

For any clarification or more information, you may contact us through the 'Get in Touch' option at
www.icicibank.com

* Mark-up fee and corresponding GST levied is included in the transaction amount displayed

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement