Closure Form Citi Bank 606u4k

CLOSURE REQUEST FORM Date: D D M M Y Y Y Y

DETAILS Name

:

Number Type

Branch :

: :

#

c Current

c Savings (Resident)

c NRE

c NRO

c FCNR

Purpose of closure : Please Note: (i) All s linked to the above such as EEFC/FCY s for Current s; Employee Reimbursement (ERA), Deposits and Junior s for Savings s, DEMAT and DMF s will also be closed. (ii) If the above has a linked DEMAT/DMF , please ensure that all holdings in the DEMAT/DMF are zeroised before applying for closure. (iii) For NR s: In case of closure of a Term Deposits, the indicated deposit will be pre-liquidated.

DESIRED MODE OF RECEIPT* OF THE BALANCE AMOUNT Currency : c USD c EURO

(Please fill in the details for any of the options given below, as applicable, and strike out the rest) (This is applicable only for NRE s and FCNR deposits for Foreign currency telegraphic transfers or demand drafts. All other transfers will be in INR.)

c GBP c SGD c CAD c AUD

c To another bank by electronic transfer/Foreign Currency Telegraphic Transfer Other bank no.

Reconfirm : No.

:

CV/BAN/ACF/Ver1.0/05-14

Name of holder : Type

: c Savings

Bank Name

:

IFSC/SWIFT Code

:

c Current

Category

: c Resident

Branch/City

:

c NRE

c NRO

c By Demand Draft Address for dispatch

: c Mailing

c Non-Mailing

c Other Address

c To another Citibank in India Citibank

City :

:

Name of holder :

RECIPIENT ADDRESS DETAILS Line 1

:

Line 2

:

(Required only for Foreign Currency Telegraphic Transfers or Demand Drafts to be dispatched to “Other Address”. Please strike out this section if not applicable)

City : State

Country :

:

PIN/ZIP :

Number : Country Code

Area Code

I/We understand, agree and acknowledge that Citibank shall act solely on the basis of my/our instructions without any responsibility and liability upon the Bank. I/We further declare that I/We have already destroyed all cheque leaves and related card pertaining to above .

CUSTOMER SIGNATURE (To be signed by all -holders):

Signature (1st Holder)

Signature (2nd Holder)

Signature (3rd Holder)

FOR BANK USE ONLY Instruction received by

:

c Mail/Representative

Complete set of originals received

:

c Yes

c In Person

c No

ID Type:__________________________ ID Number: _________________ Customer met in person by

:

(1) Name:________________________ Signature: __________________ Emp. ID: _____________ (2) Name:________________________ Signature: __________________ Emp. ID: _____________

Signature verified by #

:

Name:________________________ Signature: __________________ Emp. ID: _____________

Company s should be accompanied by a Board Resolution. *Cannot be made to third-party s