ACCOUNT CLOSURE REQUEST FORM

07/01/2021
Date:

The RBL Bank

<<Address of the Branch>>

Customer Name (s) : MOHAMED RAFEEK MOHAMED ILYAS

Customer ID : 10624430

Address for future correspondence :

Telephone # [Res] :

Telephone # [Off] :

Mobile # : +33 753 11 94 81

E-mail Address : rafeekmekgce@gmail.com

I / We authorize you to close the account(s) listed in Section A below. The balance in the account(s), after recovery of any interest,
tax, cost or charges etc.. payable by me / us, is to be repaid to me as indicated in Section B
Section A: Account Number (s)

n Savings Bank :

n Current :

n Fixed Deposit : 709002142410

n Recurring Deposit :

Note: This form is not be used for closure of retail loans / lockers / Demat / Wealth Management

Section B: The balance in account (s) is to be repaid as follows: Choose one option only:

n Transfers vide NEFT / RTGS or Telegraphic Transfer (less applicable charges) as per the application enclosed.

n Bank draft (less applicable charges)

n Transfer to my RBL Bank Account

I/We do hereby return unused cheques bearing number ………………………. to………………….. (duly cancelled), Debit card, ATM card
along with the pass book of the account. Pass book of the account may be returned to me/us duly filled in as same is
required for accounting purpose.

I/We hereby declare that all unused cheques leaves, Debit / ATM cards have been destroyed by me / us.

I/We agree and understand that any un-presented cheques, ECS and Standing Instructions in the accounts received by
the Bank after the date of account closure will stand dishonored by the Bank and I/We agree to indemnify the Bank
against any actions, proceedings, claims and /or demands, whatsoever in nature that may arise due to such dishonor.

I/We agree and confirm that I/We shall provide separate instructions to Bank for closure of Lockers / Demat Accounts /
Wealth Management Accounts / Loans availed by me / us, as applicable.

I/We agree and understand that the Bank shall have a right of set off and general lien over the amount payable to me/us
under any other account or otherwise after closure of the aforesaid account and the Bank shall be entitled to recover any
and all outstanding amount including interest, charges, TDS and/or any other related charges.

I/We agree and understand that any charges (which includes but not limited to pre closure payment charges) as per the
applicable tariff will be deducted from my/our account.

I/We agree and understand that the Bank accepts no responsibility for any loss, delay, error, omission or mutilation which
may occur in the transfer of funds and I/We agree to indemnify the Bank against any actions, proceedings, claims and/or
demands that may arise in connection with such loss, delay, error, omission, mutilation..

I/We do hereby agree to keep indemnified the Bank against any claim or loss that may occur due to any act or omission by
me/us.

Note: All account holders are required to sign this form and authenticate all corrections or amendments (if any)

Sole / First Account Holder Joint / Second Account Holder Third & Other Joint Account Holder

Confirmation of Receipt of All Dues

I/We do hereby confirm that I/we received the amount of Rs…………………………….. ( Rupees.......................................................................

…………………………………………………………….) which includes interest and in full settlement of the ….......………… account / ………........….. Deposit
bearing No……….....…………. with ……………...........……. Brach of The RBL Bank and nothing is due to me by the Bank

Date : …..................…….............

Place : ………….......................…… Signature of the Depositor