Ozg FEMA Consultant
Phone # 09811415831-37-61-72-84-92-94
Annex
[Annex
to A. P. (DIR Series) Circular No. 90
dated
March 06, 2012]
Application
cum Declaration for purchase of foreign exchange under the Liberalised
Remittance Scheme of USD 200,000 for Resident individuals
(To be completed by the applicant)
I. Details of the applicant
a. Name …………………………..
b. Address…………………………
c. Account No……………………..
d. PAN No………………………….
II. Details of the foreign exchange
required
1. 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 financial year (April- March) 20__
– 20__
Date :………………
Amount :………….
VI. Details of the Beneficiary
1. Name ……………………..
2. Address ……………………
3. Country ……………………
4*. Name and address of the bank……………………….
5*. 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, ………………. …………(Name), hereby declare that the total amount of
foreign exchange purchased from or remitted through, all sources in India
during the financial year as per item No. V of the Application, including
utilisation of the said limit on account of loan extended or gift made in
rupees credited to NRO account of non-resident close relative(s), is within the
limit of USD 200,000/- (US Dollar Two hundred thousand only), which is the
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)
Signature
of the natural guardian of the applicant @
(Name)
@ Where the
applicant is minor, the application should be countersigned by minor’s natural
guardian
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 issued by the
Reserve Bank from time to time under the Scheme.
Name and designation of the authorised
official:
Place:
Signature:
Date:
Stamp and Seal
Ozg FEMA Consultant
Phone # 09811415831-37-61-72-84-92-94
