Name : ACCOUNT CLOSURE REQUEST FORM Date: D D MM Y Y YY Please Note: (i) All accounts linked to the above account such as EEFC/FCY accounts for Current Accounts; Employee Reimbursement Account(ERA), Deposits and Junior accounts for Savings Accounts lso be closed. , DEMAT and DMF Accounts will a (ii) If the above account has a linked DEMAT/DMF account, please ensure that all holdings in the DEMAT/DMF account are zeroised before applying for account closure. (iii) For NR accounts: In case of closure of a Term Deposits, the indicated deposit will be pre-liquidated. 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 account. CUSTOMER SIGNATURE (To be signed by all account-holders): st Signature (1 Account Holder) nd Signature (2 Account Holder) rd Signature (3 Account Holder) *Cannot be made to third-party accounts Line 1 : Line 2 : City : State : Country : c By Demand Draft Purpose of closure : Branch : Account Number : ACCOUNT DETAILS DESIRED MODE OF RECEIPT* OF THE BALANCE AMOUNT (Please fill in the details for any of the options given below, as applicable, and strike out the rest) c To another bank account by electronic transfer/Foreign Currency Telegraphic Transfer Branch/City : Bank Name : Name of account holder : City : Citibank Account : c To another Citibank account in India Name of account holder : Other bank account no. Reconfirm Account No. : : Account Type : # c Current Account c Savings Account (Resident) c NRE c NRO c FCNR # Company accounts should be accompanied by a Board Resolution. IFSC/SWIFT Code : RECIPIENT ADDRESS DETAILS (Required only for Foreign Currency Telegraphic Transfers or Demand Drafts to be dispatched to “Other Address”. Please strike out this section if not applicable) Currency : USD EURO GBP SGD CAD AUD c c c c c c (This is applicable only for NRE accounts and FCNR deposits for Foreign currency telegraphic transfers or demand drafts. All other transfers will be in INR.) c Mailing c Non-Mailing c Other Address Address for dispatch : PIN/ZIP : Contact Number : Country Code Area Code Signature verified by : Emp. ID: _____________ Signature: __________________ Name:________________________ ID Number: _________________ ID Type:__________________________ Instruction received by : c In Person c Mail/Representative c Yes c No Complete set of originals received : FOR BANK USE ONLY Signature: __________________ Emp. ID: _____________ Name:________________________ (2) Customer met in person by : Signature: __________________ Emp. ID: _____________ Name:________________________ (1) Account Type : c Savings Account c Current Account Account Category c NRE c NRO c Resident : CV/BAN/ACF/Ver1.0/05-14