Form 9

Request for Account Closure

DBFS Group, III/947, Smart Centre, MKK Nair Road, Vazhakkala, Kochi-682021
Ph: 0484-3060000, 3060200-206 E-Mail: helpdesk@dbfsindia.com

DP ID 1 2 0 3 2 8 0 0 Client ID
Trading Code Segment Cap. Mkt. Commodity

I/We have been operating the referred trading/demat account with your company at _____________
Branch. I / We the client/ first Holder / Joint Holders / Guardian (in case of Minor) request you to close my /
our account with you from the date of this application and release the balance amount/shares outstanding
in my/our after deducting account closure charges, if any, as per company’s procedure. The details of
my/our account are given below:

Account Holder’s Details

Name of the Client / First Holder
Name of the Second Holder
Name of the Third Holder
Address for Correspondence
City State PIN

Details of remaining security balances (shares) in the account (if any)

Reasons for Closing the Account
Balance shares 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 shares present in a/c for (To be filled by DP, if applicable)

□ Ear – marked □ Pledged □ Pending for Dematerialization □ Frozen
□ Pending for Dematerialization □ Lock-in

Details of remaining account balances (funds) in the account (if any)

Balance amount outstanding as on date of application
Equity : Rs…………………………./-
Commodity: Rs………………………../-
Net amount to be paid after deducting closure charges of Rs.100+service tax: Rs…………………………./-
Note: In case of account debit, please attach a cheque for the debit amount + Rs.100 (& service tax) for
closure charges.
Declaration
1. I/We have verified my/our account statements and holding statements and have found all entries made
there in correct and is in agreement with the contract notes and bills issued to me/us.
2. I/We have no claim against M/s DBFS Securities Ltd /DBFS Derivatives and Commodities Ltd., its
Directors or employees except for the amount (mentioned above) remaining as credit in my/our ledger
statement.
3. 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

Place:
Date:

______________________________________

(For Office Use Only)

Account Closure Request Received on:

Remarks:

Trading account closed on: