APPENDIX 21 A

FORMAT FOR DEPOSIT OF APPLICATION FEE

Bank Receipt Number and Date

Receipt of Cash paid into the Central Bank of India at .............................. TO BE FILLED IN BY THE REMITTER B! #ho" tendered Na"e$ desi'nation and address of the person on #hose ehalf "one! is paid F%ll partic%lars of the re"ittance and of a%thorit! *if an!+ &"o%nt Head of acco%nt To e filled in ! the depart"ent officer of the ank &cco%nts Order to e officer ! Bank( #ho" ad5%sta le

Rs. Na"e

,. -./0 forei'n trade e1port pro"otion 2 "inor head 2 -34 i"port licence application fee ,a! and &cco%nts officer .......... *Na"e of station+ Date$ correct receipt and 'rant receipt *si'nat%re and f%ll description of the officer orderin' the "one! to e paid in+

)i'nat%re ( *in #ords+ R%pees

( To e %sed onl! in the case of re"ittance to the Bank thro%'h Depart"ental Officer &cco%ntant Date Bank officer

Cashier NOTE67 -. 4.

,artic%lars of "one! tendered sho%ld e 'i8en elo#. In case #here direct credits at Bank are per"issi le the Col%"n 9Head of &cco%nt9 #ill e filled in ! the Bank Officer or ,a! and &cco%nts Officer as the case "a! e$ on the receipt of Bank:s dail! state"ent &MO;NT

,&RTIC;L&R)

Coins Notes *#ith details+ Che<%e *#ith details+ Total Rs.