Close account request form - Personal - HSBC

Close account request form - PersonalPlease complete the form in BLOCK CAPITALS. Please tick where applicable and ensure that no blank or partially completed forms/documents are signed and handed over to the Bank staff.Date:_______________________Customer name(s)AddressFuture correspondenceCityCountryTel (Off.)Tel (Res.) State PIN code E-mail Mobile_______________________________________________________________________________________________________________________I/We authorise you to close the account listed below. The balance in the account, after the recovery of any interest, tax or chargespayable by me, is to be repaid to me as indicated on page 2.Customer numberSavings/Currentaccount numberFixed deposit number(s)Other accounts**Please provide separate requests for closure of Demat account/Wealth management/Retail loans/Credit cards/Lockers.Please tick the reason for closure of the account.Code Reason for Closure Code Reason for Closure1. Account moved within HSBC 6. Accountholder deceased2. Unable to maintain the minimum balance/charges too high 7. Dissatisfied with the service/product features3. Inactive account/not being used 8. Resigned from corporate (salary account)4. Moved to non-HSBC bank location/inconvenient bank location 9. Others5. Interest rate not competitivePlease specify _____________________________________

Close account request form - PersonalThe Balance in the account is to be repaid as follows: (choose any one option only) Transfer vide NEFT/RTGS or Telegraphic Transfer (less applicable charges) as per the application enclosed.(Kindly complete separate NEFT/RTGS/TT application form as applicable)(NEFT - mandatory for all amounts below `1,000) Bank draft (less applicable charges) to be mailed to the future correspondence address. Transfer to my HSBC Account __________________________________________________________________________________________________________________________________________________________________I/We hereby declare that all the unused cheque leaves, debit/ATM cards have been destroyed by me/us.I/We agree and understand that any unpresented cheques, ECS and Standing Instructions in the account received by the Bank after thedate of account closure will stand dishonoured by the Bank and I/We agree to indemnify the Bank against any actions, proceedings, claimsand/or demands that may arise due to reason of such dishonour.I/We agree and confirm that I/We shall provide separate instructions to the Bank for closure of the Safe deposit lockers/Demat accounts/Credit cards/Wealth management accounts/Retail loans, if held by me/us.I/We agree and confirm that I/We shall provide suitable amendment instructions to concerned asset management company, in case theaccount being closed above is a settlement account for wealth management services availed of from the Bank.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 after closure ofthe aforesaid account and the Bank shall be entitled to recover any outstanding amount including interest, charges, TDS and/or any otherrelated charges.I/We agree and understand that any charges as per the applicable tariff will be deducted from my/our account. Please refer to the applicablecharges on www.hsbc.co.inI/We agree and understand that the Bank accepts no responsibility for any loss, delay, error, omission or mutilation which may occur inthe transfer of funds or for any misinterpretation and I/we agree to indemnify the Bank against any actions, proceedings, claims and/ordemands that may arise in connection with such loss, delay, error, omission, mutilation or misinterpretation.Note: All accountholders are required to sign this form and authenticate all corrections or amendments (If any).Sole/First accountholder Joint/Second accountholder Third and Other Joint accountholdersFor bank use onlySignature of Authorising Official RMS Ref. # NameCARF 11/13Issued by The Hongkong and Shanghai Banking Corporation Limited, India (HSBC). Incorporated in Hong Kong SAR with limited liability.