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Date: 07th May 2015.

Name of the corporate:

Delivery of ForexPlus Card and Foreign Currency Notes


I confirm for having received USD

GBP EURO

CAD CHF

AUD SGD

AED JPY

Please fill in the following information:


Employee
__Satyanarayana_________________________________________________________________________________
Employee Number: ____10618827____________
Name: Puppala

Name:

Date of Birth: __15/06/1963_____________Mothers Maiden

Designation:Associate Manager Passport Number: _H6195604_______________


Passport Expiry Date:
29/06/2019
Postal
Address:
_Accenture
service
P
Ltd,
perungal
athur____________________________________________________________________________________
________________________________________ City: _chennai________________ __ Pin code: ________________________
Place
of
Issue:
_Bangalore__________________
Mobile:
__s.nimmala@accenture.com__
_____________

_8056018107_________________

Email:

Country of Travel: _UK_______________________ Date of Travel: __9th of May_____________ Days of Travel: 6


months________________
Travel Portal Number: _____________________________________
Details of ForexPlus Card and Currency Notes delivered:
Forexplus Card Number: ____________________________________________Reference Number: _________________
Card Amount: _____________Currency Type: _________ Amount of Currency in Cash: _____________________
Amount in Words (Only Cash Amount):
Denominations
X
X
X
X
Total

Currency series

Currency series

Currency series

I hereby apply for the issue of a HDFC Bank Forexplus Card to me and declare that the information included in the application form is true and
correct and that I am a resident Indian and that I am eligible to apply for an internationally valid card. I accept that HDFC Bank is entitled in
its absolute discretion to accept or reject this application without assigning reasons whatever. It is my responsibility to obtain the terms and
conditions applying to the HDFC Bank Forexplus Card Separately and read the same. If this application is accepted. I will be bound by the
terms and conditions governing the HDFC Bank Forexplus Card, as may be in force from time to time and use of this card shall be deemed to
be acceptance of these terms and conditions. I authorize HDFC Bank and or its associates to verify any information or otherwise at my
office/residence or to contact me, my Employer/ Banker / Credit Bureau/ RBI or any other source to obtain or provide any information that may
be required for confirming membership requirements or maintaining my account in good standing. I agree to an ongoing confirmation for use
of my name/address, email/ mobile nos. for marketing / merchandising offers between HDFC Bank and other companies. I understand and
acknowledge that the local laws and RBI rules and regulations lay down norms and limits for purchase and use of foreign exchange. I
undertake that the usage of HDFC Bank Forexplus card by me will be in accordance with the exchange control regulations of RBI and
applicable laws in force from time to time. In particular and without limitation, the FEMA act 1999, in event of failure on my part to do so or in
the event of any information supply by me being incorrect or inaccurate. I agree that I will be solely liable for any penalties and / or action
under the local laws and/or regulations as may be in force, governing the purchase and use of HDFC Bank Forexplus Card.

Signature
of
Passenger:
10618827__________

_______________________

(Delivery

Authorized official (HDFC Bank): _________

Confirmation)

Employee

No:

(A. Rajendran)

The Manager
HDFC Bank Ltd.
Chennai
Date:
Sub: release of foreign exchange under business travel and Declaration Cum Undertaking (Under Section 10(5) Chapter III of FEMA,
1999)
Dear Sir / madam,
We hereby request you to issue foreign exchange as per details given below:
TRAVELLERS NAME
PASSPORT NO.
DATE & PLACE OF ISSUE
DATE OF EXPIRY
NATIONALITY
DESIGNATION
PURPOSE OF TRIP
F E TO BE ISSUED
COUNTRIES TO BE VISITED
DURATION OF STAY

: Nimmala Satyanarayana
: H6195604
: bangalore
: 29/06/2015
: Indian
: Associate Manager
: P710
1000:
: UK
: 6 months

We certify that the Company is bearing all the expenses for the trip and the foreign exchange drawn should be utilized only for the
purpose stated above.
We declare that we have not submitted and do not intend to submit any application for the same trip to the RBI or to any other
authorized dealer.
I/ We hereby declare that the transaction(s), the details of which are specifically mentioned in the schedule, hereunder does not involve
and is not designed for the contravention or evasion of the provisions of the aforesaid Act or any rule, regulation, direction or order
made there under.
I/We hereby undertake to give such information/documents before the authorized agency undertakes transactions and as may be
required from time to time as will reasonably satisfy you about the transaction in terms of the above declaration.
I/ We also understand that if I /we refuse to comply with any such requirement or make unsatisfactory compliance therewith; the bank
shall refuse in writing to undertake the transaction and shall if it has reason to believe that any contravention / evasion is contemplated
by me report the matter to Reserve Bank of India.
I/ we further declare that the undersigned has/have the authority to give this declaration and undertaking on behalf of the company.
Yours faithfully,
For Accenture Services Pvt Ltd
Signature of Applicant