Foreign Currency Deposit Scheme

III Details of the foreign exchange required

Amount (Specify currency)………………………………

2. Purpose ………………………………..

III Source of funds: ………………………………….

IV Nature of instrument

Draft…………….

Direct remittance…………

V Details of the remittance made under the scheme in the calendar year ………

Date Amount

VI Details of the Beneficiary

• Name …………….

• Address ……………………

…………………………….

* 3. Name and address of the bank……………………….

* 4. Account No………………………………….

(* Required only when the remittance is to be directly credited to the bank account of the beneficiary)

This is to authorize you to debit my account and effect the foreign exchange remittance/issue a draft as detailed above. (strike out whichever is not applicable).

Declaration

I, ………………. …………, hereby declare that the total amount of foreign exchange

(Name)

purchased from or remitted through, all sources in India during last one year, including this application is within USD 25,000/- (US Dollar Twenty five thousands only)the annual limit prescribed by the Reserve Bank for the purpose and certify that the source of funds for making the said remittance belongs to me and will not be used for prohibited purposes. 

Signature of the applicant

(Name)

Certificate by the authorised dealer

This is to certify that the remittance is not being made by/ to ineligible entities and that the remittance is in conformity with the instructions contained in Reserve Bank A.P.(DIR Series) Circular No.64 dated February 4, 2004.

Name and designation of the authorized official:

Place: Signature

Date: Stamp and seal of the AD branch

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