Account Closure Request Form

Application No.
Date (D D M M Y Y Y Y)
Closure Initiated by
     

(To be filled by the BO. Please fill all the details in Block Letters in English)

To, Orbis Financial Corporation Limited 4A, Technopolis, Golf Club Road Sector – 54, Gurgaon – 122002

Dear Sir / Madam, I / We the Sole Holder / Joint Holders / Guardian (in case of Minor) / Clearing Member request you to close my / our account with you from the date of this application. The details of my/our account are given below:

Account Holder’s Details

DP ID
Client ID
Name of First/Sole Holder
Name of Second Holder
Name of Third Holder
Address for Correspondence
City
State
Pin
Details of remaining security balances in the account (if any)
Reasons for Closing the Account
Balance remaining in the account (if any) to be:


DP ID
Client ID
Balance present in a/c for (To be filled by DP, if applicable)




DECLARATION: In case of Account Closure due to SHIFTING OF ACCOUNT:

I/We declare and confirm that all the transactions in my/our Demat account are true/ authentic.

First/Sole Holder
Name
Signature*
Second Holder
Name
Signature*
Third Holder
Name
Signature*
*If DP or CDSL initiates account closure, Signature(s) of account holder(s) not required.

Instructions to Account Holder(s)

  • Submit a duly filled RRF if the balances are to be rematerialized.
  • Submit a duly filled Delivery Instruction Slip [DIS] (off market instruction slip) if the balances are to be transferred to another a/c. This requirement is not applicable in the case of “SHIFTING OF ACCOUNT”.