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Please fill in using BLOCK LETTERS Please () wherever applicable * Date :

Applicants Information ( Sender / Remitter )

* Name of Sender / Remitter : _________________________________________________________________________________________________________________________ * Contact Tel. No. ____________________________________________________________________________________________________________________________________ * Status : * Constitution : Transfer Instructions Resident NRI Proprietorship Foreign National Partnership Limited co. Others : ______________________________________________(Please Specify) * Details of foreign exchange required Remittance of Currency for the Amount (in figures) Amount (in Words) a/c, and . _________________________________________________

I/We authorise you to debit my/our savings/current/EEFC/RFC

* account no. remittance amount and * charges from * (1) Issue a Demand Draft : * (2) Effect a Telegraphic transfer :

______________________________________________________________________ (E.g. USD 1000.00) Remittance of Currency Amount (in figures) Amount (in words) Equivalent of Currency . _________________________________________________

______________________________________________________________________ (E.g. USD equivalent of INR 45000.00) 57 Beneficiarys Bank * Beneficiary Banks Name : * Address : * Country : ____________________________________________________________________________________________

____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ For Euro payment : in UK outside UK For AUD : in Australia outside Australia BSB Code : Swift Code : Swift Code : Sort Code : Swift Code :

_______________________________________________________________________________________________________________________ * Please fill up any of the following ( as applicable ) : For USD payment : in USA outside USA in UK outside UK in any country 59 Beneficiary Fedwire No : Swift Code : Sort Code : Swift Code : Swift code :

For GBP payment :

For any other currencies :

* Name (Student name & ID in case of payment to University) : _____________________________________________________________ * Address : ______________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ * A/c No (for payment outside UK and Europe) : ___________________________________________________________________________ * Country : ______________________________________________________________________________________________________________ * IBAN (for payment in UK and Europe only) : _____________________________________________________________________________

* Purpose of 70 Remittance (Give full details) 71 72


* All local and overseas charges to be borne by beneficiary (BEN) Bank to Bank Information (if any ) :


All local and overseas charges to be borne by remitter (OUR)


Local charges to be borne by remitter & overseas charges by beneficiary (SHA)

FEX Contract Details ( As Applicable) FEX Contract numbers booked __________________________________________ FEX rates :_____________________________________________________________ Contract to be picked up : YES / NO

Points to note :
(1) (2) The form must be complete in all respects. In case funds have to be routed through multiple financial institutions/banks , additional sheets may be used to give the route of funds in details.

Dealers Name : ______________________________________________

Customers Signature

I / We authorise the bank to debit the sum of amount for the lawful purpose detailed above and agree to abide by the Terms and Conditions printed overleaf

* Signature verified by : Customers Signature


(Name of the Staff with ID) _______________________________________________

Terms and Conditions : In requesting the Bank to make the Telegraphic Transfer / Demand Draft overleaf, I/We hereby agree that it is to be despatched in accordance with the following conditions : Fema Declaration needs to be signed compulsorily In the absence of specific instructions to the contrary, the Telegraphic Transfer / Demand Draft will be effected in the currency of the country in which payment is to be made. All charges / commission incurred outside India are for the beneficiarys account unless specified. The Bank reserves the right to draw this Telegraphic Transfer / Demand Draft on a different place from that specified by the remitter if operational circumstances so require. Telegraphic Transfer is to be dispatched entirely at the remitters own risk and for a Demand Draft, the Bank will not be responsible for mail service failure if it is dispatched on behalf of the customer. Where the Bank is unable to provide a firm exchange rate quotation, the Bank shall effect the remittance on the basis of a provisional exchange rate which shall be subject to adjustment when the actual exchange rate is ascertained. Any difference between the provisional rate and the actual rate shall be debited / credited (as the case may be) to the Applicants account. The Bank is at liberty to send the telegraphic transfer either literally or in cipher and the Bank accepts no responsibility for any loss, delay, error, omission or mutilation which may occur in the transmission of any message or for its misinterpretation when received. Applications received will be processed on the availability of market rates and applications for same day value are subject to cut-off times related to the geographical location of the destination. Encashment of the Remittance is subject to any exchange control or restrictions which may be imposed by the rules and regulations of the country where encashment is to be made. Neither the Bank nor its correspondents shall be liable for any loss or delay caused by any such rules and regulations. The Bank reserves the right to revise all Telegraphic Transfer charges from time to time without prior notice.

* Declaration
(Under FEMA 1999) I, __________________________________________________________________________________________________________ declare that 1) The total amount of foreign exchange purchased from or remitted through, all sources in India during this calendar / financial / academic year _____________ including this application is within USD . (USD

___________________________________________________________________________________________________ only) the annual limit prescribed by Reserve Bank of India for the said purpose. 2) Foreign exchange purchased from you is for the purpose indicated above. (Strike out whichever is not applicable) ____________________________________ Signature * Date : Name _______________________________________

For delivery of Demand Drafts Please deliver the Demand Draft to bearer Mr/Mrs ______________________________________________________________________________ whose signature is appended below.

________________________________ (Signature of the Bearer) I hereby acknowledge receipt of the Demand Draft specified overleaf

________________________________ (Signature of the Remitter)

________________________________ (Signature of the Bearer)

For office use only

AD Code No. __________________________________________ Form No. ______________________________________________ Currency ________________________________ Amount _________________________________ Equivalent to Rs _____________________________ (To be filled in by Authorised Dealer)

Please put a tick against an appropriate purpose code :

Capital Account Transactions (00)
S0001 S0002 S0003 S0004 S0005 S0006 S0007 S0008 S0009 S0010 S0011 S0012 S0013 S0014 S0015 S0016 S0017 S0018 Indian investment abroad in equity capital (shares) Indian investment abroad in debt securities Indian investment abroad in branches Indian investment abroad in subsidiaries and associates Indian investment abroad in real estate Repatriation of Foreign Direct Investment in India- in equity shares Repatriation of Foreign Direct Investment in India- in debt securities Repatriation of Foreign Direct Investment in India in real estate Repatriation of Foreign Portfolio Investment in India in equity shares Repatriation of Foreign Portfolio Investment in India in debt securities Loans extended to Non-Residents Repayment of long and medium-term loans with original maturity above one year received from Non-Residents. Repayment of short-term loans with original maturity up to one year received from Non-Residents. Repatriation of Non-Resident Deposits (FCNRB/NRERA etc) Repayment of loans & overdrafts taken by ADs on their own account. Sale of a foreign currency against another foreiqn currency Purchase of intangible assets like patents, copyrights, trade marks etc. Other capital payments not included elsewhere Payments for surplus freight/passenger fare by foreign shipping companies opearting in India. Payment for operating expenses of Indian shipping companies operating abroad. Freight on imports - Shipping companies Freight on exports - Shipping companies Operational leasing (with crew) -Shipping companies Booking of passages abroad - Shipping companies Payments for surplus freight/passenger fare by foreign Airlines companies operating in India, Operating expenses of Indian Airlines companies operating abroad Freight on imports - Airlines companies Freight on exports - Airlines companies Operational leasing (with crew) -Airlines companies Booking of passages abroad - Airlines companies Payments on account of stevedoring, demurrage, port handling charges etc Remittance towards Business travel. Travel under basic travel quota (BTQ) Travel for pilgrimage Travel for medical treatment Travel for education (including fees, hostel expenses etc.) Other travel (international credit cards) Postal services Courier services Telecommunication services Satellite services Construction of projects abroad by Indian companies including import of goods at project site Payments for cost of construction etc. of projects executed by foreign companies in India. Payments for Life insurance premium Freight insurance - relating to import & export of goods Other general insurance premium Reinsurance premium Auxiliary services (commission on insurance) Settlement of claims Financial intermediation except investment banking - Bank charges, collection charges, LC charges, cancellation of forward contracts, commission on financial leasing etc. Investment banking - brokerage, underwriting commission etc. Auxiliary services - charges on operation & regulatory fees, custodial services, depository services etc. S1102


S0801 S0802 S0803 S0804 S0805 S0806

Hardware consultancy/implementation Software consultancy/implementation Data base, data processing charges Repair and maintenance of computer and software News agency services Other information services - Subscription to newspapers, periodicals Franchises services - patents, copyrights, trade marks, industrial processes, franchises etc. Payment for use, through licensing arrangements, of produced originals or prototypes (such as manuscripts and films) Merchanting services - net payments ( from Sale & purchase of goods without crossing the border). Trade related services - commission on exports / imports Operational leasing services (other than financial leasing) without operating crew, including charter hire Legal services Accounting, auditing, book keeping and tax consulting services Business and management consultancy and public relations services Advertising, trade fair, market research and public opinion polling service Research & Development services Architectural, engineering and other technical services Agricultural, mining and on-site processing services-protection against insects & disease, increasing of harvestyields, forestry services, mining services like analysis of ores etc. Payments for maintenance of offices abroad Distribution services Environmental services Other services not included elsewhere S1101 Audio-visual and related services -services and associated fees related to production of motion pictures,rentals, fees received by actors, directors, producers and fees for distribution rights. S1102 Personal, cultural services such as those related to museums, libraries, archives and sporting activities; fees forcorrespondence courses abroad. Maintenance of Indian embassies abroad Remittances by foreign embassies in India Remittance by non-residents towards family maintenance and savings Remittance towards personal gifts and donations Remittance towards donations to religious and charitable institutions abroad Remittance towards grants and donations to other governments and charitable institutions established by the governments. Contributions/donations by the Government to international institutions Remittance towards payment / refund of taxes. Compensation of employees Remittance towards interest on Non-Resident deposits (FCNRB/NRERA/ NRNRD/NRSR etc.) Remittance towards interest on loans from Non-Residents (ST/MT/LT loans) Remittance of interest on debt securities -debentures /bonds/FRNs etc. Remittance towards interest payment by ADs on their own account (to VOSTRO a/c holders or the OD on NOSTRO a/c.) Repatriation of profits Payment/ repatriation of dividends Refunds / rebates / reduction in invoice value on account of exports Reversal of wrong entries, refunds of amount remitted for non exports Payments by residents for international bidding

Computer and Information Services (08)

Royalties and License Fees (09)

S0901 S0902

Other Business Services (10)

S1001 S1002 S1003 S1004 S1005 S1006 S1007 S1008 S1009 S1010 S1011 S1012 S1013 S1014

Transportation (02)
S0201 S0202 S0203 S0204 S0205 S0206 S0207 S0208 S0209 S0210 S0211 S0212 S0213 S0301 S0302 S0303 S0304 S0305 S0306 S0401 S0402 S0403 S0404

Personal, Cultural and Recreational Services (11)


Government not included elsewhere (g.n.i.e.) (12)

S1201 SI 202 S1301 S1302 S1303 S1304 S1305 S1306 S1401 S1402 S1403 S1404 S1405 S1406 S1407 S1501 S1502 S1503

Travel (03)

Transfers (13)

Communication Services (04)

Income (14)

Construction Services (05)

S0501 S0502

Insurance Services (06)

S0601 S0602 S0603 S0604 S0605 S0606

Others (15)

Financial Services (07)

S0701 S0702 S0703

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