ACCOUNT SERVICES FORM-II (Closure & Maintenance)

THIS IS A MACHINE READABLE FORM. It should be completed in "ENGLISH CAPITAL" letters.

Date: D D / M M / Y Y Y Y Branch Name:

Saving/Current/FD/DPS Account Number:

Account Title:

CASA Closure Fixed Deposit (FD) Encashment Fixed Deposit (FD) Interest Payment Scheme (DPS) Closure

FD Face Value: E To be en-cashed before maturity for FD/DPS:

_________________________________________
(Space for customer additional signature for premature FD/DPS encashment)
Please encash/pay interest/close the above mentioned CASA / Fixed Deposit/ DPS account (please cancel any standing instructions on this account and collect
duly discharged original FD Receipt / Advice / Scheme Certificate; if applicable) and pay the total balance with accrued interest (if applicable), after realization
of all applicable charges, as per the following instructions:
Fund Transfer to Account No. _______________________________________
(Space for BM approval if CB of FD/MTD/Scheme/CASA account is different from
Pay Order fund transfer account)
Payment Through: EFT RTGS (*Please fill up & attach respective request form- EFT for any amount and RTGS for one (1) lac equal or/& above any amount)

Others (specify)

*If CB of primary account is different from fund transfer account, please mention beneficiary account holder’s relationship, account title and his /her signature.

Beneficiary Signature
E-TIN: Yes No ________________________
Change FD Tenor Change FD Maturity Instruction Change Both FD Tenor & Maturity Instruction
*Reissue FD with “Principal Amount” “Principal Amount with Accrued (earned) Interest”
*New Maturity Instruction: *New Tenor: Days/ Month(s) / Year(s)
Renew Both Principal & Interest/Profit OR
Renew Principal Only and Credit Interest/Profit to the A/C No. OR
Encashment at Maturity to My / Our Account No.
*Credit Interest to and Charge Realization A/C No.
Note: Consider this tenor / maturity instruction changes request as a rectification of existing account opening form.

Regularization of DPS Installment

Number of Installment(s) Due: Details of Month:

Amount Per Installment: Total Installment Amount Due:

Debit Due Installment & Charge Realization A/C No.

I/we have authorized the above instructions and agreed to the relevant Terms, Conditions and Clauses of The City Bank Ltd. I/we also agreed to pay the
relevant fees & charges applied.
“Space for confirmation of customer(s) physical
presence with Bank official sign and seal”

______________________ Note for Tenor & Maturity instruction change: __________________________

Signature of 1st Applicant All joint – account holders are required to sign regardless of mode of operation. Signature of the Joint Applicant
FOR BRANCH USE ONLY
If customer wants to receive fund through pay order, please specify
S O L 0 1 4 1 0 0 0 0 3 8
account no. here:
We the undersigned confirm that all the related document(s) are in order as per CBL Ops Manual/SOP/Related circulars and all necessary
approval(s) are taken.

Action Taken by CS Official Recommended by BOM/Designated Official

Approved by BM/ Designated Official
(with seal & sign) (with seal & sign)
(with seal & sign)
 (This page is only applicable for CASA closing and FD/ DPS encashment)

Please Select Account Closure Reason

 Too many accounts  Leaving the country

 Higher interest rate in other banks/Organization  Negative words in the market

 Dissatisfaction with the service  Misbehavior/non-assistive attitude from the branch

 Dissatisfaction with other facilities  Higher service charge

 Inconvenient branch location  Emergency cash requirement

 Inconvenient ATM location  Investing in Sanchaypatra

 Company salary account change  FD Matured

 Loan not disbursed  DPS Matured

 Loan Adjustment  Card Dues Adjustment

 BG Claim Adjustment  LC Margin Adjustment

 Force Closure for Loan Recovery  Force Closure for Card Recovery

 Deceased Payment  FD Reissue/ Tenor Change/ Scheme Code Change

 Others (Please specify):

“Space for confirmation of customer(s)

physical presence with Bank official sign
______________________ __________________________
Signature of 1st Applicant Note: All joint – account holders are required to sign regardless of mode of operation. Signature of the Joint Applicant