ACCOUNT CLOSURE FORM

(For Savings Account)

Date:

Service Request Number: (for office use)

Account Number:

Mobile Number: ___________________________________________________________________

Customer name: ____________________________________________________________________

________________________________________________________________
E-mail ID: ________________________________________________________________________

I/We wish to close my/our Savings Account and request ICICI Bank to transfer the closure proceeds
as below:
 Transfer to ICICI Bank Account Number held in the name of:

________________________

 NEFT/RTGS –

Bank name:

Branch:

IFSC:

Account Number:

Account holder’s name:

Self-attested copy of proof of ID enclosed - Aadhaar/PAN Card/Voter ID/Valid Driving

License/Valid Passport. (Please tick on the applicable document).

Customer Declaration
I/We understand that at the time of Account closure:
 In case the Account is dormant/inactive, it will be activated to process the closure request
 There are no pending transactions, lien or ‘freeze’ in this Account
 No transactions are to be initiated and no cheques should be issued
 Access to all channels linked to this Account will be disabled
 Existing Quantum Optima Accounts will be closed
 All ATM/Debit Cards, unused cheques and Standing Instructions linked to this Account shall
be cancelled
 All NACH/ECS/Auto-Debit mandates linked to this Account have been amended
  If a Salary Account is closed, Employee Reimbursement Account (ERA), if any, will also be
closed
 Closure proceeds will be paid after deduction of bank charges, if applicable.

Customer signature(s):

__________________ __________________ _________________

(Primary Applicant) (Joint Applicant 1) (Joint Applicant 2)

All holder(s) must sign the Account Closure request.