Savings/Current Account Closure Form

Date: / / Account number

I/We ___________________________________ con rm that all unused cheques issued to me/us have been
enclosed/destroyed by me/us. No. from __________to ___________ I/We also authorize the bank to destroy all the
unu lised cheques if any in the system.
I/We are enclosing /destroying the ATM/Debit card issued to me /us.
No.1 No.2.

Reason for closure of Account

Sr no. Reason Please Select
1 De ciency in Branch services
2 Monthly/Quarterly/Half yearly changes on higher side
3 Shi ed to other loca on where there is no Axis Bank
4 Monthly/Quarterly/Half yearly balance on higher side
5 Dissa s ed with the present product o ering
6 Moving to other bank-Foreign/Private Bank
7 Moving to other bank- Na onalise/Co-opera ve Bank
8 Opening the account in some di erence scheme code
9 Deceased case/Change in cons tu on /legal case
10 Other rela onship with the banks are closed
The Bank may contact you for further discussion at your registered number post which the closure process will be
ini ated. In case you would like to be contacted at an alternate number, please provide the details.

Mobile No.____________________________ Landline No. (with STD code) _________________________________

DESIRED MODE OF RECEIPT OF THE BALANCE AMOUNT

Please
Pleaseselect
ll in the
the desired mode
details for anyof
ofremittance
the op ons forgiven,
receiving a closer procedure.
as applicable and strike out the rest.
NEFT/RTGS
1.Notes: All linkages to the above account
Account Type: will also beAccount
Saving closed Current Account
Bank Details: Bank Name
To another bank account by electronic transfer.
Other Bank Account No: IFSC Code:
Reconfirm
Other bankBank Account
Account No. No:
Name of the Account holder:
Recon rm Account No
2. To Another Axis Bank Account:
3.By Demand Draft (Will be delivered only at the mailing address and cannot be made to third party accounts).
Name of the Account holder
Enclosure: • Branch to tally name, account number and ifsc code men tioned on the cheque with the details
Account Type mentioned Saving Account
on the request. Current Account
• Cancelled cheque copy to be attached along with the request if the closure proceeds are
Bank Name >₹25000.

Branch/City IFSC Code

By Demand Dra (Will be delivered only at the mailing address and cannot be made to third party accounts)
To another account in India

Axis Account City

Name of account holder

Enclosure:
• Cancelled cheque copy to be a ached along with the request. In case of non-personalised cheque,
kindly provide copy of passbook or statement of account.
• Branch to tally name, account number and ifsc code men oned on the cheque with the details
men oned on the request.
 Declaration: -
Declara on: - • The fund transfer will be governed by the Terms and Conditions given on our website
• The fund transfer will be governed by the Terms and Condi ons given on our website
www.Axisbank.com
www.Axisbank.com
• I/We understand that as per RBI Circular dated October 14,2010 transfer of funds through electronic
• I/We modeunderstand that asonly
will be executed peronRBIthe
Circular dated
basis of October number
the account 14,2010oftransfer of funds through
then beneficiary electronic
provided while
mode will the
initiating be executed onlyDetails
transaction. on the will
basis
beofconsidered
the account number
basis of then
cheque bene ciary or
copy/passbook provided while
statement
ini a ng the
provided transac
along on. closure
with the Details will be considered basis cheque copy/passbook or statement
form.
• Iprovided
understandalong with
that the
this closure
facility form.
is available only at select location and banks covered under Electronic
• IFundsunderstand that this facility is available
Transfer Facility o ered by RBI. only at select loca on and banks covered under Electronic
Funds Transfer Facility o ered by RBI.
• I/We declare that above details are true and correct and the account is in my/our name.
• I/We declare that above details are true and correct and the account is in my/our name.
• DD /PO will be issued if mode of remittance is not selected.
Our following standing instruc on may be dealt with as per the instruc on wri en there against

Sr No Par cular of Standing Instruc on To be dealt with (Cancel/Transfer to account

no

Names and Signature of all applicants: in case of more signatories please use addi onal form

Sr No Name Signature
Authorised Signatory
Authorised Signatory
Authorised Signatory

BANK USE ONLY

Date of Account Opening ________________________

CVS ( Circle the op on to select)

Branch Head Name:

______________________________________________________________________________________________

Branch Head Employee No.__________________________ Branch Sol id ___________________

Branch Head Signature______________

Following has been destroyed

ATM Card Destroyed Y N
Unused cheque leave destroyed Y 1 N 1
1 1
In case of company account necessary board resolu on obtained Y N
Following have been delinked from the account 1 1
Standing Instruc on No ____________Osc No _____________Locker No____________Demat Account No___________

Approval enclosed for lien removal /charge reversal Cer ed that this Request le er is complete in all aspect
Branch Head & all relevant documents are obtained &veri ed Mode of
Circle Head 1 Opera on and signature of the A/c. The request may
Product Head 1 please be processed
1
Signature _______________ Designa on___________
Opera on Head Branch Head S.S No
1 1
Signature Veri ed ____________________ Employee No.__________________
(Name of the employee)

Acknowledgment
We acknowledge receipt of Saving/Current account closure form by you in favour of
Name of account holder: Account No.:

Branch stamp and sign Date of Receipt