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ee eee FOREX CARD-RELOAD / REFUND FORM (For Referral use only) Rea Agen Name eteral ode Soraurea Sam Gowen Matt Currency Forex Garé [__] Single Curency Forex Card care no Custer: Date: ane [MeN] or (eat rato arf is Bank NC RELOAD ‘ai Bank TrevelCrenoy Reload Amount) iss Bank Travel Currency Reload Amount a Frign us Pas County of Travel 1 2 4 A 5 Dat of Travel Ni, o Days a Travel Pupose of travel [EJ Busness [_Eovemion LJ Medica! [| Palday/Lesue [Emigration [_]Plgrimage [_] others] Prose cose | Deszipton| Pe) [Ll Ar Ticket [-] Copy of Passport [_] Form 60 PAN Coy Mandatory foreach amaunis ovr €20 000 Buceuod cash amount up ®o,000) [| cheque / DD Amount ‘customer D xi Bank Acstunt Amount B,C Aecount He, PAN No Fre cureney FIC Aout on Words) Satay [7] Buisness come [] Rentheome [- ]otners *fcaton with person funding the Card: Se Spouse| Parent |_| others “er blanephne en ein ‘Secn 1:8 person chal be deemed toe a lave of anotber i and ony i (bey are members of Hindu undivded fami or Hey are husband and wi; oe) the ones related tothe tern te manner inated below Fae Qn ling septate Moser dnctuing stepmotne Son reutng stepson) son's ite Davgtner Daughter's husband Broter ftusng steprate) Sse incuting stepsister) DECLARATION FOR PURCHASE OF FOREIGN EXCHANGE UNDER THE LIBERALISED REMITTANCE SCHEME OF USD 250,000 Detais of he remitances made transactions oleced under th Scheme in tha cent nancial year Ari![_| _]March Sr.No. Date exnt Name an Adress of AD branch FMC trough which he ransacton has bee eeted No Wether under LS Yes/No) Purpose Code Design Aspe te Annex sere tno tite eee el ett ogy erg sutton Pushes iottinna th seis teeta aemarsey sada Feupecarynv thir eee neat nesta eto sriaet noone ou aan. di ite eR Serer a wnsrnt emtentnetant mn eteetonen pe EE tet pee Fence ele « ESSEaeeeeme cies eh ren onan ' ane noo oy on aan ieescrmeeasinemonenmedienns ‘etrarsewnabefos echogrvlitbe edt reibepepons. , Eeeeaeaeanarere | eam eae Ce town a «SER ee nereeeat i eyecenan anen oer fete onary Sieeahietgnantatseaaea emcees terse «Siem ott antes sone Hepomnettmon seminar et 2 EE st trometer oy ace sscgnsnanpne mene Scam ou, Lwin teranienttthemmnesereee Maur neresderndnauirarteLoctiestonmncetoene, "ces/menennn sek eed Eee eeceatonentearingtentdnene he Saou tera ear angi ars sc ae 28 eed 11 aes yout debit my ou account number abovealong with your appliable charges Fosign Convitson Tx, CommisanSersceTax. a Se ctatiareheareur css aumtmrnrtin BIRR Se seats atic eomer momenta SRS ieeciasahioteciomamerremescte cats Sisueatest incre mame onc mye ty, Fra doen on at oa neers a Vere Woy Ores 1 SEE ERE SSS con rmeratrnronteras ee reustnnepratar ener arucndecrineicatan ae emactoe essa se hg yorker % anne ane sy ge bese he Samet cn tage Sh em thts elder neha cay becca ay aa be eu cet be Se saa ‘Bisrebrtindars as ron core ste ee vy. Dieses ened’ thet gaeay Ak erase bunhpe ‘nes tinach comnts cine ace ufeinetek ‘iter tne ener tom eee Seba en bce re nen sedi my Cid Seeen ont stcre bs ne acon aS Set nednae pcan sre scape Ean pen orb cn tat crops SpovectOveuedgarsen/ ete trento steal reams oathecatrdgedbyabertwtriin ‘and eect the eavel car funding, 28 detalles ‘is Bank Travel Cureney Balance Amount ae Bank Trove Cureney Refund Arount | ‘ts Bank Travel Geney Transtr to RECA ‘ais Bank NC No. PEE un ‘stiomakdsiamentssrigibiondemnnnaindy asereoeus opens FOR BRANCH USE ONLY by tae an ate entace ln catty wt lorcet Ree Baka te tise Sena, FarNT sioner, VR css oe ranevOperan eas Mc gece cow hh extents aerial hans leering Gankrecas raed Me argh ah seared documentos sue by eres ere sve ent, ‘sits cei hatte ecane ot bra ‘lie han ig nec tara sane anatomy ‘sheep ko se a ein Seay sateen oa eh ng Ines ae ee ve eet oe ye abe sen cy a ‘versace om buon a al on {pM leone sconces macs Fo Fon ca cont fee been FU x Bae tare Enotes 0 ae tore ety FOR CPU USE ONLY Wee by ‘ters. Adon Remas

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