Application For Closure of Demat Account (NSDL/CDSL) : Ddmmyyyy

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ICICI Bank Limited, CPC-Demat Services, Ground Floor, B-Wing, Autumn Estate, Chandivali Farm Road, Opp.

Mhada Colony, Chandivali, Andheri (East), Mumbai - 400072.


(Important Note : Please do not send requests directly to this address. Kindly route all your requests through the nearest ICICI Bank Demat Servicing Branches)
Application for Closure of Demat Account (NSDL/CDSL)

Date D D M M Y Y Y Y DP ID Client ID (of account to be closed)

I / We hereby request you to close my / our Demat account with you as per following details:

Sole/First Holder

Second Holder

Third Holder

* Please tick the applicable option(s): (*Marked is a Mandatory field )

Option A (There are no balances / holdings in this account)

Option B Target Account Details


(Transfer the Transfer to my / our own account
balances / (Provide target account details and NSDL DP ID
holdings in enclose Client Master Report of Target
this account as Account)
per details given) CDSL
Transfer to any other account (Submit
duly filled Delivery Instruction Slip Client
signed by all holders) ID

Option C [Rematerialise / Reconvert (Submit duly filled Remat / Reconversion Request Form - For Mutual Fund units)]

* Please tick the reason for closing the Demat Account: (*Marked is a Mandatory field )
Moving to new area/abroad where ICICI Bank does not have a branch Unsatisfactory services
High demat charges Stopped trading forever
Consolidation of accounts Others (Please specify)

Recovery of dues

Direct Debit
Please debit my ICICI Bank Account(A/c No. for recovery of any pending dues against
my account

Cheque Payment
Cheque Number............................................................... drawn on Bank...........................................................................................................

Cash Payment

DECLARATION: In case of Account Closure due to Shifting of Account:


I/We declare and confirm that all the transactions in my/our Demat Account are true/authentic.
V - Dec 2017

SIGNATURE OF SOLE/FIRST HOLDER SIGNATURE OF SECOND HOLDER SIGNATURE OF THIRD HOLDER

Acknowledgement
We hereby acknowledge the receipt of the your request for closing the below mentioned Demat Account subject to verification:

DP ID Client ID

Demat Account Holder’s Name

Received by

Bank Official Signature Branch SR No

Date D D M M Y Y Y Y

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