Online Application Form

Dear Customer, this is an Online Application Form for Surat Money Prepaid Card. Please fill this form and complete the application & generate a Reference Number.
This Reference Number can be quoted at any issuance counter of Surat Municipal Corporation Civic Center to obtain your Surat Money card

Mr    Ms    Mrs   

KYC Details

Disclaimer : As per new RBI guildelines, please complete your basic KYC. No document uploads required.
                     Any one of the following KYC Detail is mandatory.
**Enter only last 4 digit of aadhar number
I accept all declarations pertaining to ICICI Bank Surat Money Prepaid Card Application.(Please click here to view all declarations)
I do / do not have objections to ICICI bank Ltd., its group of companies, agents/ representatives to provide me/us information on various products, offers and services provided by ICICI Bank Ltd./ its group of companies through any mode (including without limitation through telephonic calls / SMSs / Emails) and authorize ICICI Bank Ltd., its group of companies, agents/representatives for the above purpose.