Ozg FEMA Consultant
Phone # 09811415831-37-61-72-84-92-94
Report by the Indian
company receiving amount of consideration for issue of shares / Convertible debentures under the FDI
Scheme
(
To be filed by the company through its Authorised Dealer Category – I bank,
with the Regional Office of the Reserve Bank under whose jurisdiction the
Registered Office of the company making the declaration is situated, not later
than 30 days from the date of receipt of the amount of consideration, as
specified in para 9 (I) (A) of Schedule I to Notification No. FEMA 20/2000- RB
dated May 3, 2000 )
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Permanent
Account Number (PAN) of the investee company given by the IT Department |
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No.
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Particulars
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(In Block Letters)
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1. |
Name of
the Indian company Address of the Registered Office |
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Fax |
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Telephone |
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e-mail |
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2 |
Details
of the foreign investor/ collaborator |
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Name Address
Country
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3.
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Date of
receipt of funds |
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4.
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Amount |
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5.
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Whether
investment is under Automatic Route or Approval Route
If
Approval Route, give details (ref. no. of approval and date)
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Automatic
Route / Approval Route |
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6.
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Name
of the AD through whom the remittance is received
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7.
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Address
of the AD
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A
Copy of the FIRC evidencing the receipt of consideration for issue of shares/ convertible debentures as above is enclosed.
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(Authorised
signatory of
the
investee company)
(Stamp)
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(Authorised
signatory of
the AD)
(Stamp)
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FOR USE OF THE
RESERVE BANK ONLY:
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Unique Identification
Number for the remittance received:
Know Your Customer (KYC)
Form in respect of the non-resident investor
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Registered Name of the Remitter /
Investor
(Name, if the investor is an Individual)
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Registration Number (Unique
Identification Number* in case remitter is an Individual)
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Registered Address (Permanent
Address if remitter Individual)
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Name of the Remitter’s Bank
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Remitter’s Bank Account No.
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Period of banking relationship with
the remitter
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*
Passport
No., Social Security No, or any Unique No. certifying the bonafides of the
remitter
as
prevalent in the remitter’s country
We
confirm that all the information furnished above is true and accurate as
provided by the overseas remitting bank of the non-resident investor.
(Signature
of the Authorised Official
of
the AD bank receiving the remittance)
Date :
Place:
Stamp :
Ozg FEMA Consultant
Phone # 09811415831-37-61-72-84-92-94
