gd (oye A a TU Bert nied cP Drmt Sarvs, round as, Bing Aun Ete, Cheval Fu Rot Op. Mada Coby Chanda Aus oa) aC 400072. Hae a et onae do nt sondvequersdrecly otis adders. Kina sute all your requests treugh the nearest CI ‘Bank Demat Serving Branches) ~Apploation for Closure of Demat Account (NSDL/COSL) z IZ] int 0 (Fr accounto be closed) ia] ‘as per following details: vate (FTTH T2 To To" orio [ZN 3] F101! 1/ We heteby request you'to clase my / our Dernat account with you: Sole/Fist Holder Rfolerelr] sz Mah l ‘Second Holder T ! | Third Holder eel ee option(s): (‘Marked Is a Mandatory field) re ne balances / holdings in this account) Target Account Details I Onion ronsfertno | (2) Transfer to my /our own account "1 7 balsnces/ Provide target occount dewis end | (] NSOL] DD holdings in: Enclose Gent Master Report of Target . this account 5 Account) per dete o¥6") | — anor wo any oer account iSubmit™| 1°54 dui led Delvery inswuction Sip len Signed by all holders), I Ta Onion (Remetrnive/ Reserve (Submit duly filed Remat/Roconvarsion Request Form -For Mutal Fund nis Please tick the reason for closing the Demat Account: ("Marked is 2 Mandiatery field | TL Moving to now erea/broad where ICICI Bankdoes nathave a branch [_] Unsatisfactory services [Digh demat charges Stopped taxing forever 5 onsoidation of accounts other eene soos) covery of dues (direct Debit Prnme dot my WIG Back AccourtAleNo.{Z [5]6 [4 [0] [510 ]4 [4] S12 for covery of any pendine dues apsinat my account (D1 Cheque Payment Cee i Pees Tl cash Payment Refund of charges: a Reland ot a est asnetnnteriel oA Cage none tN IC ce pe os eae ha Cpt eon Asoo Won Be emant ee I i ‘DECLARATION: In case of Account Closure due to Shifting of Account: =a eee an recital th tonacione In myit ema ezaunt ae tuceuthonts fi ea l \ ~~" BIGHATURE OF 801 ERRST HOLDER SIGHATURE GF SECOND HOLDER r “SIGNATURE GF THAD HOLBER — ea mrs Wie hereby scnovledge the ieceint of te yaur request for sng the below mentioned Demat Account subject o verison: cro CCTTTTTT) «=o CCT) ‘Demat Acceunt Holder's Name ‘ecelved by. Bank Official Signature Branch SR No.ae”