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Issued by the Hongkong and Shanghai Banking Corporation Limited in Bangladesh [October 2019] Page 1 of 1
The Hongkong and Shanghai Banking Corporation Limited Date
Incorporated in the Hong Kong SAR with limited liability
Savings/Current Account Closure Form
The Manager
HSBC, Bangladesh Branch
Please close my/our account number and pay the net balance by:
D D M M Y Y Y Y
Savings Certificates/Bond Informations
n Savings Certificate/ Bond purchase from HSBC Bank account
n Savings Certificate/ Bond purchase from other bank by using HSBC Bank account
I/We understand that HSBC accepts no responsibility for any loss or delay which may occur in the transfer, transmission and /or application of funds or (in the
case of remittance by telegraphic transfer) for any error, omission or mutilation which may occur in the transmission of any message or for its misinterpretation
when received and I/we agree to indemnify HSBC against any actions, proceedings, claims and /or demands that may arise in connection with such loss, delay,
error, omission, mutilation or misinterpretations. I/we undertake to pay HSBC on demand the full value of any transactions on my/our Debit Card which have not
yet been processed together with any charge applicable.
I/We acknowledge that I am/we are responsible for destroying any unused cheque leaves and/or debit card which were not returned by me/us to HSBC, at the
time of account closing.
Please process my/our request as mentioned above and deduct applicable charge(s) from my/our HSBC account number
Signature of 1 st applicant Signature of 2 nd applicant Signature of 3 rd applicant
Signature and photo verified by HSBC official
(seal with name, designation and date)
BM’s endorsement
(seal with name, designation and date)
Executed by HSBC official
(seal with name, designation and date)
Approved by HSBC official
(seal with name, designation and date)
Name of 1 st applicant Name of 2 nd applicant Name of 3 rd applicant
(Please tick ( ü ) where applicable)
n Cash
n Transfer to my/our account number
n Demand Draft (DD)
n Telegraphic Transfer (TT)
*Issuance of DD/TT, please fill up the Smart Form
along with supporting documents
Future Correspondence Address
Contact Number
NID/Smart Card/Passport Number
n Cashier’s Order (CO) *Please fill the details below only for issuance of CO.
Beneficiary Name
Beneficiary Account Number
Beneficiary Bank Name
Contact Number of the beneficiary
Address of the beneficiary
Reason for Account Closure: To be filled up by the customer (Please tick ( ü ) where applicable)
n Accessibility issues – Branch/Telephone
n Accessibility issues –Online/Mobile
n Complaints
n Complex/lengthy processes and procedures
n Dissatisfied with staff behaviour
n Mis-informed/Mis-sold product
E
J
K
H
Q
C
n Dissatisfied with the product/features
n Expiry of promotions
n Identified more competitive product
n Dissatisfied with the fees/charges/pricing
n Moving away
n No longer use the product/features
P
O
R
I
L
N
n Personal circumstances change
n Refused to provide reason
n Sale of property/windfall
n Staff errors
n Unhappy with the policy
M
T
F
S
U
To be filled up by HSBC (Please tick ( ü ) where applicable)
n Credit Reasons (Bad debt etc.)
n Deceased
n Others (X), please specify…………………………………………………………………………………
V
D
n Dormant/Inactive Account closed
n Global Standards/FCC/CSEM closure
Y
G
Name of the security items to be handed over
n Un-used/Un-presented Cheques Cheque number from ……………………...….......…..... to…………..………..………......…..... enclosed herewith
n HSBC Debit Card
Cancel the card(s) with immediate
effect and DEBIT my/our account for
the entire amount outstanding.
Standing Instruction(s)
n Cancel with immediate effect n Transfer to account number (Please specify)
……………………………………………………………………………................……………… (1st applicant card)
…………………………………………………………………………................……………...… (2nd applicant card)
…………………………………………………..................……….. (3rd applicant card) Card(s) enclosed herewith
✓