www.icicibank.com Open in urlscan Pro
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Form analysis
1 forms found in the DOM

Name: qa-callback-form — POST

<form id="lead-form-1" name="qa-callback-form" method="post" data-formname="<p class=&quot;title&quot;> Want us to help you with anything? <br> Request a Call back</p>" data-formtype="lead form" ajax-page="/content/icicibank.apigee.json?">
  <div class="form-group">
    <div class="input-group">
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            fill="#3D3D3D"></path>
        </svg>
      </div>
      <div class="input-box">
        <input type="text" placeholder="First name" class="input-name" id="qa-fname" name="fname" autocomplete="off" tabindex="0">
      </div>
      <span id="fname-err" class="error-txt">This field is required</span>
      <span id="fname-num-err" class="error-txt">Only alphabetes are allowed</span>
    </div>
    <div class="input-group">
      <div class="icon">
        <svg width="18" height="21" viewBox="0 0 18 21" fill="none" xmlns="https://www.w3.org/2000/svg">
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            fill="#3D3D3D"></path>
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            fill="#3D3D3D"></path>
        </svg>
      </div>
      <div class="input-box">
        <input type="text" placeholder="Last Name" class="input-name" id="qa-lname" name="lname" autocomplete="off" tabindex="0">
      </div>
      <span id="lname-err" class="error-txt">This field is required</span>
      <span id="lname-num-err" class="error-txt">Only alphabetes are allowed</span>
    </div>
  </div>
  <div class="form-group">
    <div class="input-group">
      <div class="icon">
        <svg class="mob-svg" width="17" height="23" viewBox="0 0 17 23" fill="none" xmlns="https://www.w3.org/2000/svg">
          <path d="M13.8437 1H3.15363C1.97284 1 1.01562 1.94091 1.01562 3.10159V19.9143C1.01562 21.075 1.97284 22.0159 3.15363 22.0159H13.8437C15.0245 22.0159 15.9817 21.075 15.9817 19.9143V3.10159C15.9817 1.94091 15.0245 1 13.8437 1Z"
            stroke="#4B4B4B" stroke-width="1.5" stroke-linecap="round" stroke-linejoin="round"></path>
          <path d="M8.49219 17.8125H8.50189" stroke="#4B4B4B" stroke-width="2" stroke-linecap="round" stroke-linejoin="round"></path>
        </svg>
      </div>
      <div class="input-box">
        <input type="text" placeholder="Your Mobile Number" class="input-mobile" id="qa-mob-num" name="mob-num" autocomplete="off" tabindex="0" maxlength="10">
      </div>
      <span id="mob-err" class="error-txt">Please enter valid number</span>
    </div>
    <div class="input-group">
      <div class="icon">
        <svg width="18" height="12" viewBox="0 0 18 12" fill="none" xmlns="https://www.w3.org/2000/svg">
          <path
            d="M15.9757 0H1.53942C0.690583 0 0 0.690583 0 1.53942V10.4606C0 11.3094 0.690583 12 1.53942 12H15.9757C16.8246 12 17.5152 11.3094 17.5152 10.4606V1.53942C17.5152 0.690583 16.8246 0 15.9757 0ZM15.7748 1.02628L15.5694 1.19736L9.36835 6.36094C9.01442 6.65562 8.50066 6.65562 8.1468 6.36094L1.94579 1.19736L1.74033 1.02628H15.7748ZM1.02628 1.76718L6.07872 5.97434L1.02628 9.33688V1.76718ZM15.9757 10.9737H1.53942C1.29147 10.9737 1.08409 10.7969 1.03658 10.5628L6.90159 6.65952L7.49012 7.1496C7.85732 7.45537 8.30748 7.60825 8.75761 7.60825C9.20774 7.60825 9.65786 7.45537 10.0251 7.1496L10.6136 6.65952L16.4786 10.5628C16.4311 10.797 16.2237 10.9737 15.9757 10.9737ZM16.4889 9.33688L11.4364 5.97438L16.4889 1.76718V9.33688Z"
            fill="#3D3D3D"></path>
        </svg>
      </div>
      <div class="input-box">
        <input type="text" placeholder="Email" class="input-email" id="qa-email" name="email" autocomplete="off" tabindex="0">
      </div>
      <span id="email-err" class="error-txt">Please enter valid email</span>
    </div>
  </div>
  <div class="form-group">
    <div class="input-group multiselect-dropdown">
      <div class="icon">
        <svg width="20" height="19" viewBox="0 0 20 19" fill="none" xmlns="https://www.w3.org/2000/svg">
          <path
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            fill="#3D3D3D"></path>
          <path
            d="M9.50718 18.9996C9.43593 18.9996 9.36467 18.9806 9.30213 18.9426C9.18416 18.8706 9.11133 18.7423 9.11133 18.6038V9.49914C9.11133 9.34951 9.19604 9.21254 9.32984 9.14525L18.4281 4.59294C18.5493 4.53118 18.6965 4.53752 18.8129 4.61035C18.9301 4.6824 19.0013 4.80986 19.0013 4.94683V13.8535C19.0013 14.0008 18.919 14.1362 18.7884 14.2043L9.69007 18.9545C9.63306 18.9846 9.56973 18.9996 9.50718 18.9996ZM9.90304 9.74378V17.9506L18.2096 13.6136V5.58732L9.90304 9.74378ZM18.6055 13.8535H18.6134H18.6055Z"
            fill="#3D3D3D"></path>
          <path
            d="M0.396676 5.34363C0.251002 5.34363 0.111662 5.26366 0.0419916 5.12512C-0.0561801 4.92956 0.0237823 4.69205 0.219334 4.59388L9.3303 0.0415646C9.44193 -0.0138549 9.57335 -0.0138549 9.68419 0.0415646L18.7825 4.59388C18.978 4.69205 19.0572 4.92956 18.9598 5.12512C18.8617 5.32067 18.6249 5.39905 18.4286 5.30246L9.50764 0.838022L0.574019 5.30167C0.517016 5.33017 0.456846 5.34363 0.396676 5.34363Z"
            fill="#3D3D3D"></path>
          <path
            d="M14.2522 11.8748C14.0336 11.8748 13.8563 11.6975 13.8563 11.479V7.3692L4.97652 2.92614C4.78097 2.82876 4.70179 2.59046 4.79997 2.39491C4.89814 2.19936 5.13565 2.12098 5.3312 2.21757L14.4295 6.76988C14.5633 6.83797 14.648 6.97494 14.648 7.12457V11.479C14.648 11.6975 14.4707 11.8748 14.2522 11.8748Z"
            fill="#3D3D3D"></path>
        </svg>
      </div>
      <div class="input-box quick-action-select">
        <select id="product-type" name="product-type[]" class="product-type jqmsLoaded ms-list-1" multiple="multiple" style="display: none;">
          <option value="AL"> Auto Loan </option>
          <option value="PL"> Personal Loan </option>
          <option value="HL"> Home Loan </option>
          <option value="CC"> Credit Card </option>
          <option value="SIP"> Insta SIP </option>
          <option value="MFSIP"> Mutual Funds </option>
          <option value="MSIP"> Money Coach </option>
          <option value="ELSS"> ELSS </option>
          <option value="SA"> Savings Account </option>
          <option value="TWL"> Two Wheeler Loan </option>
        </select>
        <div id="ms-list-1" class="ms-options-wrap"><button type="button"><span>Select product type</span></button>
          <div class="ms-options" style="min-height: 200px; max-height: 1180px;">
            <ul style="column-count: 1; column-gap: 0px;">
              <li data-search-term="auto loan"><label for="ms-opt-1"><input type="checkbox" title="
                      Auto Loan
                    " id="ms-opt-1" value="AL"> Auto Loan </label></li>
              <li data-search-term="personal loan"><label for="ms-opt-2"><input type="checkbox" title="
                      Personal Loan
                    " id="ms-opt-2" value="PL"> Personal Loan </label></li>
              <li data-search-term="home loan"><label for="ms-opt-3"><input type="checkbox" title="
                      Home Loan
                    " id="ms-opt-3" value="HL"> Home Loan </label></li>
              <li data-search-term="credit card"><label for="ms-opt-4"><input type="checkbox" title="
                      Credit Card
                    " id="ms-opt-4" value="CC"> Credit Card </label></li>
              <li data-search-term="insta sip"><label for="ms-opt-5"><input type="checkbox" title="
                      Insta SIP
                    " id="ms-opt-5" value="SIP"> Insta SIP </label></li>
              <li data-search-term="mutual funds"><label for="ms-opt-6"><input type="checkbox" title="
                      Mutual Funds
                    " id="ms-opt-6" value="MFSIP"> Mutual Funds </label></li>
              <li data-search-term="money coach"><label for="ms-opt-7"><input type="checkbox" title="
                      Money Coach
                    " id="ms-opt-7" value="MSIP"> Money Coach </label></li>
              <li data-search-term="elss"><label for="ms-opt-8"><input type="checkbox" title="
                      ELSS
                    " id="ms-opt-8" value="ELSS"> ELSS </label></li>
              <li data-search-term="savings account"><label for="ms-opt-9"><input type="checkbox" title="
                      Savings Account
                    " id="ms-opt-9" value="SA"> Savings Account </label></li>
              <li data-search-term="two wheeler loan"><label for="ms-opt-10"><input type="checkbox" title="
                      Two Wheeler Loan
                    " id="ms-opt-10" value="TWL"> Two Wheeler Loan </label></li>
            </ul>
          </div>
        </div><span tabindex="0" id="product-type-button" role="combobox" aria-expanded="false" aria-autocomplete="list" aria-owns="product-type-menu" aria-haspopup="true"
          class="ui-selectmenu-button ui-selectmenu-button-closed ui-corner-all ui-button ui-widget"><span class="ui-selectmenu-icon ui-icon ui-icon-triangle-1-s"></span><span class="ui-selectmenu-text">&nbsp;</span></span>
        <span id="product-type-err" class="error-txt">Please select product type</span>
      </div>
    </div>
    <div class="input-group">
      <div class="icon">
        <svg width="15" height="20" viewBox="0 0 15 20" fill="none" xmlns="https://www.w3.org/2000/svg">
          <path
            d="M7.41663 0.757812C3.32708 0.757812 0 4.08489 0 8.17444C0 10.4745 1.19011 13.1459 3.53729 16.1144C5.25478 18.2866 6.94754 19.7877 7.01876 19.8505C7.24608 20.0511 7.58715 20.0511 7.8145 19.8505C7.88572 19.7877 9.57848 18.2866 11.296 16.1144C13.6432 13.1459 14.8333 10.4745 14.8333 8.17444C14.8333 4.08489 11.5062 0.757813 7.41663 0.757813V0.757812ZM7.41663 18.5792C5.98749 17.2172 1.2027 12.3449 1.2027 8.17444C1.2027 4.74807 3.99026 1.96051 7.41663 1.96051C10.843 1.96051 13.6306 4.74807 13.6306 8.17444C13.6306 12.3449 8.8457 17.2173 7.41663 18.5792Z"
            fill="#3D3D3D"></path>
          <path
            d="M12.0171 7.8183L7.80761 4.2102C7.5824 4.01717 7.25012 4.01717 7.02491 4.2102L2.81547 7.8183C2.56331 8.03441 2.53411 8.41409 2.75026 8.66624C2.96641 8.9184 3.34605 8.9476 3.5982 8.73145L4.10882 8.29374V11.2816C4.10882 11.6137 4.37807 11.883 4.71017 11.883H10.1223C10.4544 11.883 10.7237 11.6137 10.7237 11.2816V8.29374L11.2343 8.73145C11.4876 8.94858 11.8671 8.91727 12.0823 8.66624C12.2984 8.41409 12.2692 8.03445 12.0171 7.8183ZM9.52097 10.6803H5.31152V7.26284L7.41624 5.45879L9.52097 7.26284V10.6803Z"
            fill="#3D3D3D"></path>
        </svg>
      </div>
      <div class="input-box">
        <input type="text" placeholder="Pincode" class="input-pincode" id="qa-pincode" name="pincode" autocomplete="off" tabindex="0" maxlength="6">
      </div>
      <span id="pincode-err" class="error-txt">Please enter valid pincode</span>
    </div>
  </div>
  <div class="button-group">
    <button class="ic-btn" type="submit" id="leadFormOneSubmitBtn" data-linktype="button link" data-webinteractiontype="other"> Submit </button>
  </div>
  <div id="error-txt" class="error"></div>
  <div id="success-txt" class="success-txt orange-bg">
    <svg width="60" height="60" viewBox="0 0 60 60" fill="none" xmlns="https://www.w3.org/2000/svg">
      <circle cx="29.5791" cy="29.5791" r="29.5791" fill="#D3E6B4"></circle>
      <path d="M21.1289 29.5813L27.1655 36.2215L39.2386 24.1484" stroke="#219653" stroke-width="5.35236" stroke-linecap="square"></path>
    </svg>
    <h4>Thank you for your request.</h4>
    <p id="successMsg"> Your reference number is <strong>CRM </strong>
    </p>
    <p class="small"> Our executive will contact you shortly </p>
  </div>
</form>

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