TAN of the Remitter Email Address (Person making the Payment) Phone No (Person making the Payment) Name

of the Bank through which Payment is made Branch address BSR Code of Branch

Recipient of Remmitance
Complete Address of recipient of Remittance Local address PAN, if any Principal place of business Email Id ISD phone No Country to which payment to be made Currency Date of Deduction of Tax Proposed date on which payment to be made TT buying rate used for conversion purpose