Certified that this request letter is complete in all aspect & all relevant documents are obtained & verified Mode of Operation and signature
of the A/c. The request may please be processed.
We acknowledge receipt of Saving/Current account closure form by you in favour of
Dissatisf ied with the present product offering
Def iciency in Branch Services
Opening the account in some different scheme code
Moving to other Bank- Nationalise/ Co-operative BankMonthly/ Quarterly/ Half yearly charges on higher side
Shifted to other location where there is No Axis Bank
Monthly/ Quarterly/ Half yearly balance on higher side
Deceased case/ Change in constitution/ Legal case
Other relationships with the Bank are closed
Name of the
account holder:
Signature of All Applicants is Mandatory (in case of more signatories, please use another form)
Declaration
Signature of All Applicants is Mandatory (in case of more signatories, please use another form)
Account No.
Account number:
Bank Use Only
Approval enclosed for Lien Removal/ Charge reversal/CVS:
Branch Head
Circle HeadCluster Head Regional/Product Head
Operations Head Branch Head.
EMP No.
S.S No.
Date of Receipt
Signature of
Account Holder/ Authorised Signatory
Name Name Name Name
Signature of
Account Holder/ Authorised Signatory
Signature of
Account Holder/ Authorised Signatory
Signature of
Account Holder/ Authorised Signatory
Name
Designation:
Acknowledgement
NEFT/RTGS
Other Bank Account No:
Account Type:
A) B)
C)
Bank Details:
Current Account
By Demand Draft (Will be delivered only at the mailing address and cannot be made to third party accounts).
Name of the Account holder:
To Another Axis Bank Account:
IFSC Code:
Please select desired mode of remittance for receiving closure proceeds.
1.
1.
Moving to other Bank- Foreign/ Private Bank
6.
8.
9.
10.
2.
3.
4.
5.
7.
3.
2.
Reconfirm Bank Account No:
Resident Savings Account NRI:
NRE NRO
1. The fund transfer will be governed by the Terms and Conditions given on our website www.Axisbank.com. 2. I/We understand that as per RBI Circular dated
October 14,2010 transfer of funds through electronic mode will be executed only on the basis of the account number of then beneficiary provided while initiating
the transaction. 3. I understand that this facility is available only at select location and banks covered under Electronic Funds Transfer Facility ordered by RBI. 4.
I/We declare that above details are true and correct and the account is in my/our name. 5. Standing Instruction/ Demat Account/ Locker/ OSC, SB & Current A/cs,
Credit Card(s), etc will be delinked from the Account 6. I/We further declare that I/We have already destroyed/authorise Axis Bank to destroy all Cheque
Leafs/Books and ATM/Debit Card linked to above account. 7. Cancelled cheque copy to be attached along with the request if the closure proceeds are >₹25000.
8. If mode of remittance is not selected or Remittance through NEFT/ RTGS is returned due to any reason, then by default DD/ PO will be issued. 9. In case of
company
1.
2.
account necessary board resolution to be provided.
Date:
Y Y Y
Y
D D M M
Y Y Y
Y
D D M M
Middle Name Last NameFirst Name
Savings/Current Account Closure Form
(All f ields are mandatory)
Middle Name Last NameFirst Name
Name of the
account holder
Middle Name Last NameFirst Name
Desired Mode for Receipt of Closure Proceeds
Reason for Closure of Account (please select any one reason)
Signature & Branch Stamp
