Citi Bank Pakistan Account Closure Request Form

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Citi Bank Pakistan Account Closure Request Form Powered By Docstoc
					Branch: ______________

                                     ACCOUNT CLOSURE REQUEST
I / We hereby request you to close my/our following account(s):
A/C Number: ________________________________ A/C Title: _____________________________________

A/C Number: _________________________________ A/C Title: _____________________________________

A/C Number: ________________________________ A/C Title: _____________________________________

A/C Number: _________________________________ A/C Title: ______________________________________

I/We have returned all the unused check(s) and Debit Card(s) issued to me / us against the above-referred
account(s). I/We hereby indemnify and hold harmless Citibank, its employees, representatives and agents against
any or all claims, losses, damages and actions resulting from including but not limited to misuse of un-utilized
check(s) previously issued.
I/we understand and agree that according to the General Terms & Conditions applicable to my/our Account(s),
Citibank has the right to recover by adjusting/setting off all amounts payable by me/us on account of any
financing/facilities availed by me/us from time to time from the balance funds in the aforementioned Account(s).

Submissions
Unused Checks:    No [ ]      Yes [ ] Check Number(s): ____________________ to ___________________




                                                                                                                           BB - ACF – VC4 - 10 - 09
Debit Card submitted:No [ ]         Yes [ ] Debit Card Number:_______________________________________

Reason for Account Closure:          Funds Required for Personal Use        Low Profit Rate        Service Issues

  Minimum Balance Requirements             Others (please state) _________________________________________

_______________________________             ___________________________             _________________________
Account Holder's Name                              Signature & Date                          Contact No.

_______________________________             ___________________________             _________________________
Account Holder's Name                               Signature & Date                           Contact No.

Witness 1: ______________________________                     ____________________              _______________
            Name & CNIC Number                                 Signature                         Date
Witness 2: ______________________________                      ____________________             _______________
           Name & CNIC Number                                   Signature                        Date

                                                FOR BANK USE ONLY

SV:    Name: _________________ Initial: _________________              Mode:       In Person          Mail/Messenger
Checks(s): ________________ to _________________ destroyed.            Name: _______________ Initial: _______________
Debit Card #: ___________________________closed & destroyed.
                                                                       Date: _________________ Time: ___________
Witness (Name/Sign): 1 ________________ ________________
                                                                       Signature Cards Removal Confirmation
                      2 _______________        _________________       For RELATIONSHIP CLOSURE:

Customer Number: _____________________________________                 Set 1: Cash Counter       Set 2: Operations Staff

                                                                       Name: ______________ Names: ______________
Closing Balance: _______________________________________
                                                                       Initials: _____________ Initials: ______________
IMCI Exc. (For SA Only): _____________ Profit: _____________

Charges Deduction: _______________ FED: _________ Deduction by: _______________ Auth by: __________

Acc Closed: Yes [ ]      No[    ]     Relationship Closed:   Yes[ ] No[ ] Rexme Reviewed By: ____________

				
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posted:4/14/2012
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