Bajaj Financial Securities Limited
Account Closure Request Form
Application No. Date 28-May-2025
Closure Initiated by BO DP CDSL
(To be filled by the BO (in case of BO-initiated closure).Please fill all the details in Block Letter in English)
To,
Bajaj Financial Securities Limited, 1st Floor, Mantri IT Park, Tower B, Unit 9 & 10, Viman Nagar, Pune, Maharastra
411014
Dear Sir/Madam, I/We the Sole Holder / Joint Holder / 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 UCC R25949
DP ID 12088600 Client ID 11457511
Name of the First/Sole Holder Sayak Mondal
Name of the Second Holder
Name of the Third Holder
Dhanurhat K Mandirbazar Dhanurhat South 24,Parganas West
Address for Correspondence
Bengal 743336,,South 24 Parganas - 743336,West Bengal,India
City SOUTH 24 PARGANAS State WEST BENGAL PIN 743336
Details of remaining security balances in the account (if any)
Reasons for Closing the Account Due to family issue (Family not giving permission )
Balance remaining in the account (if any) to be:
Partly rematerialised and partly transferred Rematerialised
Transferred to another account (Number Not application
given below)
DP ID Client ID
Ear - marked Pledged
Balance present in account for Pending for
Frozen
(To be filled by DP, if applicable) Dematerialisation
Pending for
Lock-in
Rematerialisation
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.
Signed by: SAYAK MONDAL
Reason: Account Closure by Bajaj Financial Securities Limited
eSigned using Aadhaar (digio.in)
Date: 2025-05-28 13:57:18 IST
Bajaj Financial Securities Limited
First/Sole Holder Second Holder Third Holder
Name Sayak Mondal
Signature
Signed by: SAYAK MONDAL
Reason: Account Closure by Bajaj Financial Securities Limited
eSigned using Aadhaar (digio.in)
Date: 2025-05-28 13:57:18 IST
*If DP or CDSL initiates account closure, Signature(s) of account holder(s) not required
Acknowledgment Receipt
Application No. Date 28-May-2025
DP ID 12088600 Client ID 11457511
Name of the First/Sole Holder Sayak Mondal
Name of the Second Holder
Name of the Third Holder
Reason for Closure Due to family issue (Family not giving permission )
Depository Participant Seal and Signature
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 Account. This requirement is not applicable in the case of "SHIFTING OF
ACCOUNT"
Signed by: SAYAK MONDAL
Reason: Account Closure by Bajaj Financial Securities Limited
eSigned using Aadhaar (digio.in)
Date: 2025-05-28 13:57:18 IST
Signed by: SAYAK MONDAL
Reason: Account Closure by Bajaj Financial Securities Limited
eSigned using Aadhaar (digio.in)
Date: 2025-05-28 13:57:18 IST
