Account Closure Request Form

Application No. Date D D M M Y Y Y Y
Closure Initiated by
BO
DP
CDSL
(To be filled by the BO (in case of BO-initiated closure). Please fill all the details in Block Letters in English)
To,
SyndicateBank, Depository Services
2nd Floor, SyndicateBank Building, 26A, Sir P M Road, Fort, Mumbai – 400 001
Dear Sir / Madam,
I / We the Sole Holder / Joint Holders / Guardian (in case of Minor) / Clearing Member request you to close my / our account with
you from the date of this application. The details of my/our account are given below:
Account Holder’s Details
DP ID 1 3 0 5 0 6 0 0 Client ID
Name of the First / Sole Holder
Name of the Second Holder
Name of the Third Holder
Address for Correspondence
City State PIN
Details of remaining security balances in the account (if any)
Reasons for Closing the Account
Balance remaining in the account (if any) to be :

partly rematerialised and partly transferred.
Rematerialised

Transferred to another account (Number given below)
Not applicable
DP ID Client ID
Balance present in account for
Ear - marked
Pledged
(To be filled by DP, if applicable)
Pending for Dematerialisation
Frozen

Pending for Rematerialisation
Lock-in
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.
First / Sole Holder Second Holder Third Holder
Name
Signature *
*If DP or CDSL initiates account closure, Signature(s) of account holder(s) not required.
Depository Participant Seal and Signature
===============================(Please Tear Hear)==============================
Acknowledgement Receipt
Application No. Date :-
We hereby acknowledge receipt of your instruction for Closing the following Account subject to verification: -
DP ID 1 3 0 5 0 6 0 0 Client ID
Name of the First / Sole Holder
Name of the Second Holder
Name of the Third Holder
Reason for Closure
Depository Participant Seal and Signature
Instructions to Account Holder(s)
o Submit a duly-filled RRF if the balances are to be rematerialized.
o Submit a duly-filled Delivery Instruction Slip [DIS] (off market instruction slip) if the balances are to be
transferred to another Account. This requirement is not applicable in the case of “SHIFTING OF ACCOUNT”.