Request for Closure of PMSBY
Formal request to discontinue the PMSBY accident cover and stop the yearly premium deduction.
PMSBY closure letter workspace
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A4 · print readyPradhan Mantri Suraksha Bima Yojana
Request for Closure of PMSBY
Date: 02/09/2026
To,
The Branch Manager
BANK NAME
Branch
Subject: Request for Closure of PMSBY
Respected Sir / Madam,
I, Applicant Name, hold a savings account at your branch and am enrolled under the Pradhan Mantri Suraksha Bima Yojana (PMSBY). I request you to kindly close my PMSBY enrolment linked to the account mentioned below and discontinue the annual auto-debit of the premium from the date of this application.
Kindly acknowledge receipt of this application and complete the closure formalities at the earliest. Please confirm once the enrolment has been discontinued in the bank's records.
| Full Name | Applicant Name |
|---|---|
| Father's / Husband's Name | — |
| Mobile Number | — |
| Aadhaar Number | — |
| Address | — |
| Bank Name | — |
|---|---|
| Branch Name | — |
| Branch Address | — |
| Account Number | — |
| IFSC Code | — |
| Scheme | Pradhan Mantri Suraksha Bima Yojana (PMSBY) |
|---|---|
| Request Type | Closure of PMSBY |
| Reason for Closure | Voluntary Closure |
| Date of Request | 02/09/2026 |
Declaration
I hereby declare that the particulars furnished above are true and correct to the best of my knowledge and belief. I understand that the accident insurance cover under this scheme will cease from the date of closure and that no claim shall be admissible thereafter.
Thanking you,
Yours faithfully,
—
How to use
- 1Enter the subscriber, bank and branch details in the form.
- 2Select the reason for closing the PMSBY enrolment.
- 3Review the live preview of the letter beside the form.
- 4Download the A4 PDF or print the letter directly.
- 5Collect the customer's signature and submit the letter at the branch.
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Disclaimer
R.K Technical Support is not a bank, insurer or government body and is not affiliated with any of them. This template is provided as a drafting convenience only. Banks may prescribe their own closure form or additional documents, so please confirm the current requirement with the branch before submission.