FORM A4

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364

(To be completed for Debits and Credits to Non-residents Accounts of all types other than the Accounts of Non-residents Banks, requiring approval of Reserve Bank or for Report to Reserve Bank)

For debit

From the account of __________________________________________(Name and address of non-resident account holder stating country of residence and type of account) at_______________________________________(Name of authorised dealer or authorised co-operative /commercial bank with whom account is kept) for payment to_____________________________ (Name and address of the resident beneficiary) Amount Rs.______________________________________________(in figures) and (in words)

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The purpose of payment is __________________________For credit

From ___________________________________(Name and address of the resident remitter) for credit to the account of_______________________________(Name and address of non-resident account holder stating country of residence and type of account) at__________________________________________(Name of authorised dealer or authorised co-operative/commercial bank with whom account is kept) Amount Rs_____________________(in figures) and ( in words)

The purpose of payment is __________________________________

________

For transfer___________________________________________________

From the account of ______________________________________________

(Name and address of non-resident account holder stating country of residence and type of account) at_____________________________________________________

(Name and address of non-resident account holder stating country of residence and type of account) at______________________________________________________

(Name of authorised dealer or authorised co-operative/commercial bank with whom account is kept)

Amount Rs._____________________________________________(in figures) and (in words)

We certify that the above payment/transfer has been made in terms of the authority delegated to authorised dealers or authorised co-operative/commercial banks vide paragraph________of the Exchange Control Manual/Memorandum ABM and/ or A.D. Circular No.

________ ____________________

(Signature o authorized Official)

Name : _______________________

Designation : __________________

Name and address

Of Authorised Dealer or

Authorised Co-operative/

Commercial Bank_______________

Date :

(Space for comments of the authorised dealer or authorised co-operative/commercial bank)

While forwarding the application to Reserve Bank for approval reference to paragraph of Exchange Control Manual or Memorandum AMB or A.D. Circular in terms of which the reference is made should invariably by cited.

Similar transaction was approved by Reserve Bank vide approval No.__________dated ______

________ ____________________

(Signature of authorised Official)

Name : _______________________

Designation : __________________

Name and address

Of Authorised Dealer or

Authorised Co-operative/

Commercial Bank_______________

Date :

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