Annexure 15: C3

Account Closure Request

To,
The Manager,
HBL Microfinance Bank.
Dear Sir/Madam,
Re: Closure of Account

I/We request you to close my/our account as per the following details;
Account No. ____________________________________
Account Type: _____________________________________
Account title: _____________________________________
Reason:
________________________________________________________________
________________________________________________________________
I/we hereby surrender the un-used cheque(s) bearing numbers from __________________________
to ___________________.
You are further requested to pay me/use the balance of my/our account through Pay Order/Demand Draft/Bankers
Cheque/Cash. I/We authorize you to debit my account for deduction of closure and Pay Order/Demand
Draft/Bankers Cheque issuance charges, as applicable.

I/We indemnify HBL Microfinance Bank or any of its representatives for any loss or damage incurred by me/us as a
result of me/our instructions contained herein and I/We undertake to accept all losses arising therefrom.
Thanking You,

________________
Authorized Signature

For Office Use Only

Yes/No Remarks
1. Cheque leaves No(s). ______________________ to ______________________
obtained ___________________ and signature portions torn off in presence of customer.
2. Account marked closed in System. ____________
3. Necessary charges deducted. ____________
4. AOF, SS Card and other related documents marked as "Account Closed". ____________

__________________ ___________________
Processed By: BOM Authorized By: BM

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