Application for Closing Demat Account
Date : (dd) / / (mm) (yy)
To, ICICI Bank Limited ICICI Infotech House, Vishweshwar Nagar Rd Opp. Pravasi Industrial Estate, Goregaon (E), Mumbai 400063 I / We hereby request you to close my/our account with you. I / We request you to transfer the balances of securities to my/our account with DP name (DP ID ) bearing my Client Id
ICICI Bank DP ID I N
DP Account No. Name of the holder(s) Signature
First/Sole Holder Second Holder Third Holder Please tick the reason for closing the account: Consolidation of Demat Account(s) High Demat Charges Unsatisfactory Service (Pl. specify) Shifting to new address where ICICI Bank branch is not there (Please specify place) Others (Pl. specify)
For Office use only Details of recovery at Branch ( where payterm is Direct Debit ) Bank Account debited : Bank Account credited : 003605000732 Demat Officer (Name and Signature) : Date : Amount :
Branch Manager (Name and Signature) :
Please strike off as N. A. whatever is not applicable Please clear all outstanding dues before submitting this form
----------------------------------------------------------------- Cut from Here -----------------------------------------------------------------ICICI Bank Limited ACKNOWLEDGEMENT We hereby acknowledge the receipt of Application for Closing of Demat Account from Mr/Mrs. DP ID I N transfer the Balance of security to DP Name Client Id . For ICICI Bank Limited
Date : (dd) / / (mm) (yy)
Client Id (DP ID
. With a request to )
Authorised Signatory