INVOICE

To, Transaction Date: 23/09/2016

23/09/2016
Invioice Date:
SINGI REDDY REDDY
Invoice No. : 28398

We have delivered the Foreign Exchange to you , as per instructions received from you the details of the same as given below.
Customer Name SINGI REDDY CRN

TP No Country of Travel ITALY

Passport No M9370364 Passport Expiry Date 27/05/2025

Contact No 919642257474 Email ID NIKHILSINGIREDDY27@GMAIL.COM

Card No 4575810000160647 Account No 913020034218403

Details of Foreign Exchange as per details given below

Currency Name Type Amount Rate Total

EUR Card 646.00 77.35 49,968.10

EUR Cash 0.00 0.00 0.00

Total 49,968.10

Service Tax 74.95

Grand Total 50,043.05

Declaration :

“ I hereby apply for the issue of a Axis Bank Travel Currency Card to me and declare that the information included in the application form is true and
correct and that I am a Indian citizen and that I am eligible to apply for an internationally valid card. I accept that Axis Bank is entitled in its absolute
discretion to accept or reject this application without assigning any reasons whatsoever. It is my responsibility to obtain the terms and conditions as
applicable to the Axis Bank Travel Currency Card and read and understand the same. If this application is accepted, I shall be bound by the terms and
conditions governing the Axis Bank Travel Currency Card, as may be in force from time to time and use of the card shall be deemed to be acceptance of
these terms and conditions. I am aware that by agreeing to this I am estopped from taking a plea subsequently that I have not been aware of the Terms
and conditions. I authorised Axis Bank and / or its associates to verify any information or otherwise at my office / residents or to contact me, my
Employer / Banker / Credit bureau / RBI or any other source to obtain or provide any information that may be required for confirming membership
requirements or maintaining my account in good standing. I agree to an on going confirmation for use of my name, address, email and mobile no. for
marketing / merchandising offers between Axis Bank and others companies. I understand and acknowledge that local laws and Reserve Bank of India
rules and regulations lay down norms and limits for the purchase and the use of foreign exchange. I undertake that the usage of the Axis Bank Travel
Currency Card by me will be in accordance with Exchange Control Regulations of the Reserve Bank of India and the applicable laws in force form time
to time, in particular and without limitation, the Foreign Exchange Management act, 1999. In the event of any failure on my part to comply with the rules
and regulations or in the event of any information supplied by me being incorrect or inaccurate. I agree that I will be solely liable for any / all penalties
and / or action under the local laws and / or regulations as may be in force, governing the purchase and the use of Axis Bank Travel Currency Card. I
also understand that a Service Tax of 14.50% is applicable on all the fees, interest and other charges as the Government of India regulations and agree
to pay the same. All available amounts at the time of expiry of the cards not claimed / en-cashed with in three months from date of expiry of the card
shall lapse to the bank. In case I have applied for an Additional Card (Add- on card) available for a Resident Indian parent, spouse, brother, sister, or
child over 12 years of age or for myself. I will received the transactions details done using Add -on Card along with the Primary Card. The facility of an
Additional Card being a special facility, continuation of the membership of the Additional Card member will be dependent on the continuation of my
membership”. The Travel Currency Card can be encashed only after my return to India. Furthermore, the last transaction done on the card should be
more than 10 days prior to the date of encashment.”

Declaration Cum Undertaking

[Under Section 10(5), Chapter III of Foreign Exchanged Management Act , 1999]

I hereby declare that the transaction, the details of which are specifically mentioned in the document hereunder does not involve and is not designed for
the purpose of any contravention or evasion of the provisions of the aforesaid Act or of any rule, regulation, notification, direction or order made there
under.
I also hereby agree and undertake to give such information /documents as will reasonably satisfy you about this transaction in terms of above
declaration.I also understand that if we refuse to comply with any such requirement of make only unsatisfactory compliance therewith AXIS Bank shall
be entitled to refuse to undertake transaction, and it has reason to believe that any contravention /evasion is contemplated by us, the AXIS Bank shall be
entitled to report the matter to Reserve Bank of India. I further declare that the undersigned has /have the authority to give this declaration and
undertaking on behalf of the firm/company.

For Axis Bank

Customer Signature Stamp & Signature of Auth. Signatory

Service Tax Code : AAACU2414KST001 Category: Banking & Financial Services BEN/DIV-I/22 PAN No. AAACU2414K