For Office Use Only

Service Request No. ...............................

NRI Request to close Savings Bank Account (for Non-Resident Individuals)

FORMS (Not for closing deposits)
Note: A mandate holder cannot request for an account closure.
Date: D D M M Y Y Y Y
To,
The Branch Manager
ICICI Bank Ltd., Branch ................................................
Please close my/our Savings Bank account/s. My account details are given below.
Name of account holder/s: .........................................................................................................................................................................
Savings Account Number/s: .............................................................. E-mail address: ............................................................................
Contact number/s: .................................................................................................... Mobile No.: ......................................................................
COUNTRY CODE + AREA CODE + NUMBER

Reason for Closure

Returning to India

COUNTRY CODE + NUMBER

Charges levied

Account opened with another bank

Any other: .....................................................................................................................................................................................................

I understand that at the time of account closure
Access to all channels linked to this account will be disabled.
All the Standing Instructions in this account will be cancelled.
I/We have surrendered/destroyed ATM/Debit Card associated with this account. All ATM/Debit Card/s linked to this account will be cancelled.
The PO/DD issued for closure proceeds shall be the amount that is left over after deduction of account closure charges as applicable.
My existing Quantum Optima accounts along with the savings bank account will be closed and the relevant penal charges will be applicable on the Quantum Optima
deposits because of the closure of account.
I/We shall be responsible for amending all the ECS/Auto debit mandates linked to this account.
I have surrendered unused cheque leaves. All the used/unused/not paid/post dated cheques which are surrendered/not surrendered will be treated as
cancelled/destroyed.
For lockers linked to this account, I confirm that I have surrendered my locker/s linked to this account.
I also request you to de-link my I-Direct trading account linked to the above account (if applicable).
For Dormant/Inactive accounts: In case my savings bank account/s mentioned above is/are dormant/inactive, they will be activated to process the Account Closure
request.

Instructions for Closure Proceeds

Please pay the balance amount by (please any one of the following options)
Transferring to another ICICI Bank account, A/c Holders Name: ........................................................................................................
A/c No.: ......................................................................................................... (*refer to point 4 in Notes)
Pay Order(PO)/Demand Draft (DD) payable at ......................................................................................................................................
Beneficiarys Name: .....................................................................................................................................................................................
a) Send PO/DD (in INR) to the address mentioned below
Receivers Name* .................................................................................................. Tel No. ..................................................................
COUNTRY CODE + AREA CODE + NUMBER

DD to be mailed to (address): ...............................................................................................................................................................

.................................................................................... City ............................... Country ............................. Pin code .........................
b) Send PO/DD (in Foreign Currency: ..............................) to my correspondence address (OVERSEAS) as per bank records.
First Applicant

Joint Applicant 1

Joint Applicant 2

SIGNATURES*
(as per Bank's records)
Notes

1. Please visit http://www.icicibank.com/pfsuser/icicibank/ibank-nri/nrinewversion/service_charges.htm for more details.

2. *The signatures of all account holders are mandatory to close an account.
3. Closure proceeds of an NRO Savings account cannot be transferred to an NRE account.

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P.T.O.

Checklist
Item to be checked

Action to be initiated
by the branch

1. Dormant account

Authorise closure after

necessary checks

Tick for Verification by branch Tick for Verification by RPC

Authorised
NA

2. Check leaves destroyed

Destroy cheques and record in
physically
cheque destruction register
No.s:..........................................

3. Freeze/lien in the account

Cheques surrendered
Destroyed physically

At Base Branch: Freeze/lien to

be removed
At non-base branch: Sr to base
branch for removal of Freeze/
lien

Removed
SR created

4. Demat linked (I-direct)

account

Check if lien exists in the

account

No lien exists for trading

5. Balance available for

recovery of charges

Verify balance in account

Balance available

6. Debit balance account

Waiver of charges and debit

balance, as applicable

Charges waived

7. ATM / debit card

Cheque no.s destroyed in

system

NA

NA
Cards destroyed

Destroy physically

NA
For Branch use
1. I confirm that I have verified the identity of the above named person/s and he/they signed in my presence (only if signature/s
are not currently scanned into system):
In case of dormant accounts
2. I confirm that the request for closing the dormant account was received from a genuine source.
3. I authorise the waiver of the debit balance and account closure charges for this account.
4. I authorise the closing of the account.
Note: Waiver/Reversal of charges can be be authorized only by a Branch Head.
Name: ........................................................................................... Signature of Authorising Official: ........................................................
To be filled in by the branch

To be filled in by RPC

FCRM SR No: .............................................

Form Processed / Rejected Date: D D M M Y Y Y Y

Dated: D D M M Y Y Y Y

Reason for rejection: ......................................................................

*attach scanned image of application to SR

..........................................................................................................
..........................................................................................................

Form Acceptance date:

SOL ID of accepting Branch: .........................................................
If EC, ledger No.: ...........................................................................
*If scanning is not possible, despatch to the nearest RPC, with
SR no. clearly recorded in the column on the top right
corner of the form.

Signature: .......................................................................................
Name and Employee No.: ..............................................................
..........................................................................................................

Acknowledgement Slip
Received from: ..................................................................................... Account Number: .......................................................................
Acknowledgement for: ................................................................................................................................................................................
Ref. No.: .................................................................................................................................. Dated: .........................................................
Signature: ......................................................... Name of Signing Officer: .................................................................................................
ICICI BANK
Name: ........................................................................................................ Stamp:
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