Ver-1.
3
1st-Dec- 2017
THE BRANCH HEAD PAY IN SLIP OF FCS Annexure I
AXIS BANK LIMITED
_______________BRANCH DATE :
COLLECTION OF CLEAN INSTRUMENTS IN US DOLLAR (DD’S / CHEQUES)
UNDER FINAL CREDIT SCHEME (FCS)
DECLARATION CUM UNDERTAKING
CUSTOMER NAME
ACCOUNT NO (IN WHICH
PROCEEDS ARE TO BE CREDITED)
NAME, ADDRESS & COUNTRY OF
REMITTER
CURRENCY / AMOUNT USD
CHEQUE DETAILS - NO. & DATE
PURPOSE OF REMITTANCE
Please send the instrument for collection under your FCS as per the extant guidelines of your bank. I/We confirm that the
detail of the FCS Scheme has been explained to me.
I/WE AGREE THAT THE ARRANGEMENT WILL BE SUBJECT TO FOLLOWING TERMS AND CONDITIONS
1. THE BANK IS AUTHORIZED TO ENGAGE A CORRESPONDENT BANK/AGENT FOR REALIZING THE
PROCEEDS AND ALL OTHER ACTS AND THINGS INCIDENTAL THERETO. THE AMOUNT WILL BE
CREDITED TO MY/OUR ACCOUNT AFTER RECEIVING ADVICE OF FINAL PAYMENT FROM THE
CORRESPONDENT BANK.
2. THE FOLLOWING COLLECTION CHARGES APART FROM BANK’S STANDARD COLLECTION CHARGE
WILL BE DEDUCTED BY THE BANK FOR ALL THE INSTRUMENTS SENT FOR COLLECTION UNDER
THE ABOVE SCHEME AS GIVEN BELOW AND THE SAME ACCEPTABLE TO ME / US.
3. W.E.F 1ST DECEMBER 2017 AS PER THE ARRANGEMENT WITH CORRESPONDENT BANK AN MOUNT
OF USD 40 WILL BE LEVIED/DEDUCT BY CORRESPONDENT BANK FOR ALL USD CHEQUES/DD
AMOUNT ABOVE USD 50 THAT IS LODGED UNDER FINAL CREDIT SCHEME.
4. THE BANK NOR ITS AGENT/S WILL BE RESPONSIBLE FOR ANY LOSS OR DAMAGE DUE TO THE LOSS
OR MISCARRIAGE OF THE CHEQUES/DRAFTS OR FOR ANY DELAY IN COLLECTION, TRANSMISSION OR
OTHERWISE OF ANY REMITTANCE HOWSOEVER CAUSED
5.WE UNDERSTAND THAT AS PER FEDERAL RULE OF USA RETURNED CHEQUES WILL BE AN IMAGE
REPLACEMENT DOCUMENT (IRD) OF ORIGINAL CHEQUE AND THAT THESE SUBSTITUTE CHEQUES
WOULD HAVE THE SAME LEGAL STATUS IN USA AS THE ORIGINAL CHEQUE AND THEY CAN BE
REPRESENTED.
SIGNATURE OF THE BENEFICIARY/ATTORNEY HOLDER
For Branch Use:-
RATE: CARD MARGIN BRANCH TO REPORT TREASURY: (Y OR N)
FWD CNT NO: FWD CNT RATE:
(SIGNATURE OF AUTHORISED OFFICER)
____________________________________________________________________________
Acknowledgement
RECEIVED CHEQUE/DD NO. …………AMOUNT……………DRAWN ON………………….. FROM
(NAME)……………………………………….UNDER FCS.
DATE: SEAL SEAL AUTHORISED SIGNATORY
Ver-1.3
1st-Dec- 2017
THE BRANCH HEAD ANNEXURE -II
AXIS BANK LIMITED
_______________BRANCH DATE:
COLLECTION OF CLEAN INSTRUMENTS IN FOREIGN CURRENCY (DD’S / CHEQUES)
UNDER CASH LETTER SCHEME
DECLARATION CUM UNDERTAKING
CUSTOMER NAME
ACCOUNT NO (IN WHICH
PROCEEDS ARE TO BE CREDITED)
NAME, ADDRESS & COUNTRY OF
REMITTER
CURRENCY / AMOUNT
CHEQUE DETAILS - NO. & DATE
PURPOSE OF REMITTANCE
Please send the instrument for collection under your Cash Letter Scheme as per the extant guidelines of your bank. I/We
confirm that the details of the Scheme have been explained to me.
I/WE AGREE THAT THE ARRANGEMENT WILL BE SUBJECT TO THE FOLLOWING TERMS AND CONDITIONS
1.THE BANK IS AUTHORIZED TO ENGAGE A CORRESPONDENT BANK/AGENT FOR REALIZING THE
PROCEEDS AND ALL OTHER ACTS AND THINGS INCIDENTAL THERETO.
2.THE BANK’S STANDARD COLLECTION CHARGES WILL BE DEDUCTED FOR ALL THE INSTRUMENTS SENT
FOR COLLECTION UNDER THE ABOVE SCHEME AND THE SAME ARE ACCEPTABLE TO ME / US.
3.THE BANK NOR ITS AGENT/S WILL BE RESPONSIBLE FOR ANY LOSS OR DAMAGE DUE TO THE LOSS OR
MISCARRIAGE OF THE CHEQUES/DRAFTS OR FOR ANY DELAY IN COLLECTION, TRANSMISSION OR
OTHERWISE OF ANY REMITTANCE HOWSOEVER CAUSED
4. IF THE CHEQUES/DRAFT FOR COLLECTION IS RETURNED UNPAID AT ANY TIME,
RETURNING OR OTHER CHARGES MAY BE DEBITED TO MY/OUR ACCOUNT.
5.IF THE CHQ/DD CREDITED TO MY/OUR ACCOUNT PROVISIONALLY PRIOR TO FINAL REALIZATION IS
RETURNED UNPAID, THE AMOUNT MAY BE RECOVERED FROM MY/OUR ACCOUNT AT THE APPROPRIATE
EXCHANGE RATE ALONG WITH THE INTEREST APPLICABLE AT SUCH RATES AS MAY BE DECIDED BY YOU.
I/WE UNDERTAKE TO REFUND THE AMOUNT IMMEDIATELY ON DEMAND, WITH INTEREST AND/OR ANY
CHARGES. IF ALREADY DRAWN BY ME/US.
6.WE UNDERSTAND THAT AS PER FEDERAL RULE OF USA RETURNED CHEQUES WILL BE AN IMAGE
REPLACEMENT DOCUMENT (IRD) OF ORIGINAL CHEQUE AND THAT THESE SUBSTITUTE CHEQUES WOULD
HAVE THE SAME LEGAL STATUS IN USA AS THE ORIGINAL CHEQUE AND THEY CAN BE REPRESENTED.
SIGNATURE OF THE BENEFICIARY/ATTORNEY HOLDER
For Branch Use:-
RATE: CARD –Y / N MARGIN: BRANCH TO REPORT TO TREASURY -Y OR N
FWD CNTRACT NO : FWD CNT RATE: COOLING DAYS :
OTHERS INSTRUCTIONS: (SIGNATURE OF AUTHORISED OFFICER)
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Acknowledgement
RECEIVED CHEQUE/DD NO. …………AMOUNT……………DRAWN ON………………….. FROM
(NAME)……………………………………….UNDER CASH LETTER SCHEME.
DATE: AUTHORISED SIGNATORY
SEAL
Ver-1.3
1st-Dec- 2017
Annexure III
COVERING SCHEDULE
(BRANCH WILL PREPARE ONLY ONE PROCESS SHEET FOR THE ENTIRE LOT OF CHEQUES
SENT ON A SINGLE DAY)
B- Cat.SOL
B-CAT.BRANCH
C-CAT.SOL
C-CAT.BRANCH
(C CATEGORY BRANCH MUST MENTION B CAT BRANCH SOL AND NAME.)
WE ARE FORWARDING FOLLOWING CHEQUES TO BE LODGED UNDER
COLLECTION
CURRENCY AMOUNT NO OF CHEQUES
CURRENCY AMOUNT NO OF CHEQUES
CURRENCY AMOUNT NO OF CHEQUES
CURRENCY AMOUNT NO OF CHEQUES
CURRENCY AMOUNT NO OF CHEQUES
CURRENCY AMOUNT NO OF CHEQUES
DATE:
SIGN:
NAME:
Ver-1.3
1st-Dec- 2017
Annexure IV
FORMATS
PAY-IN-SLIP (SUPPLEMENT)
(This slip will have to be attached along with every cheque when the customer has not filled annexure-
I or II, to enable TFC to lodge and realize cheques without referring back to Branch)
B- Cat.SOL
B-CAT.BRANCH
C-CAT.SOL
C-CAT.BRANCH
(C CATEGORY BRANCH MUST MENTION B CAT BRANCH SOL AND NAME.)
A) THE FOLLOWING CHEQUE(S) IS/ARE BEING FORWARDED TO BE HANDLED UNDER FCS/CASH LETTER
SCHEME/DIRECT COLLECTION SCHEME
B) WE HAVE PURCHASED CHEQUES UNDER OUR REFERENCE NO.___________________________
C) CHEQUE COLLECTION CHARGES UNDER RESPECTIVE SCHEME HAS BEEN INFORMED TO CLIENT.
CUSTOMER NAME.________________________________ FOR TC’S ONLY
1000*
ACCOUNT NO.______________________________________ 500*
100*
CCY. ____. Amount._______. No. Of Instrument(s)
50*
20*
Purpose: __________________________________________________________
(IF PROCEEDS ARE FOR REALIZATION OF EXPORT BILL, THE BILL REF. NO. SHOULD BE MENTIONED)
SPECIFIC DISPOSAL INSTRUCTION.
A. CONVERT FULLY.-(Y/N). B. CONVERT PARTIALLY.-(Y/N). C. NO CONVERSION.___
(IF CONVERT PARTIALLY OR NO CONVERSION PLEASE ENTER THE FOLLOWING DETAILS)
EEFC A/C NO.___________________ CCY _________AMOUNT.________
RFC A/C NO. ____________________CCY _________AMOUNT________
FCNR A/C NO. ____________________CCY _________AMOUNT________
NRE A/C NO. ____________________CCY _________AMOUNT________
RATE: CARD MARGIN
BRANCH TO REPORT TO TREASURY OR .TFC TO REPORT
FWD CNT NO FWD CNT RATE
COOLING DAYS
SIGN HERE:
NAME:
DATE:
Ver-1.3
1st-Dec- 2017
Annexure V
PAY IN SLIP OF DCS
THE BRANCH HEAD
AXIS BANK LIMITED
_____________BRANCH DATE:
COLLECTION OF CLEAN INSTRUMENTS (DD’S / CHEQUES)
UNDER DIRECT COLLECTION SCHEME (DCS)
DECLARATION CUM UNDERTAKING
CUSTOMER NAME
ACCOUNT NO (IN WHICH PROCEEDS ARE TO BE CREDITED)
NAME, ADDRESS & COUNTRY OF REMITTER
CURRENCY / AMOUNT
CHEQUE DETAILS - NO. & DATE
PURPOSE OF REMITTANCE
Please send the instrument for collection under DCS as per the extant guidelines of your bank. I/We confirm that the detail of
the DCS Scheme has been explained to me.
I/WE AGREE THAT THE ARRANGEMENT WILL BE SUBJECT TO FOLLOWING TERMS AND CONDITIONS
1. The instrument is to be lodged under Direct Collection Scheme (DCS) under which Instruments are directly sent to the
Drawee Bank for Collection.
2. Based on the above information, I undertake the following responsibilities:
a. Minimum amount of the instrument collected under the scheme isof at-least 200 units of the instrument
currency.
b. All charges in addition to Axis Bank charges are to be borne by the beneficiary and are to be adjusted from the
beneficiary’s realized amount
c. Axis Bank will not be responsible for the delay in receiving nostro credit by the Drawee Bank
d. Acceptance of the Instrument is subject to it’s return in 15 days, if the Drawee Bank does not have centralized
collection hub where such instruments are to be send for collection.
3. The Bank nor its agent/s will be responsible for any loss or damage due to the loss or mishandling of the cheques/drafts or
for any delays in collection, transmission or otherwise of any remittance howsoever caused.
4. If purpose code is P0501* then "I/We confirm residential status of remitter is .......................................... and purchase of
property does not pertain to agricultural land, plantation property or farm-house."
*P0501 – Receipt on account of services related to cost of construction of projects in India.
SIGNATURE OF THE BENEFICIARY/ATTORNEY HOLDER
For Branch Use:-
RATE: CARD MARGIN: BRANCH TO REPORT TREASURY: (Y OR N)
FWD CNT NO: FWD CNT RATE:
(SIGNATURE OF AUTHORISED OFFICER)
Acknowledgement
RECEIVED CHEQUE/DD NO. …………AMOUNT……………DRAWN ON………………….. FROM
(NAME)……………………………………….UNDER DIRECT COLLECTION SCHEME (DCS).
Ver-1.3
1st-Dec- 2017
DATE: SEAL AUTHORISED SIGNATORY
SEAL
Annexure VI
DECLARATION BY THE CUSTOMER (CHOOSE IF APPLICABLE):
( ) Purpose - Advance Against Exports: we undertake that we are under an obligation to ensure
that the shipment of goods is made within one year from the date of receipt of advance payment. In the
event our inability to make the shipment partly or fully within one year from the date of receipt of
advance payment, no remittance towards refund of unutilized portion of advance payment or towards
payment of interest, shall be made after the expiry of the said period of one year, without the prior
approval of the reserve bank. If the export agreement/amendment in agreement provides for shipment of
goods extending beyond the period of one year from the date of receipt of advance payment, prior
approval of the reserve bank will be obtained. All documents relating to export of goods from india will be
submitted to an authorized dealer within 21 days of the date of shipment of the goods.
( ) Purpose - Foreign Contribution Under Fcra: we have been allotted fcra registration number
___________ by ministry of home affairs (copy enclosed). We declare that the foreign contribution
(remittance), received is not pertaining to election, correspondent, columnist, cartoonist, editor, owner,
printer or publisher of a registered newspaper, judges, government servants or employees of any
corporation, members of any legislature, political party or office bearer thereof.
( ) Purpose - Merchanting Trade: We Declare That The Following:
a) Goods involved in the transactions are permitted to be imported into India, all rules, regulations
and directions applicable to export (except Export Declaration Form) and import ( except Bill of
Entry) are complied with for the export leg and import leg, respectively.
b) The entire merchant trade transaction is/will be completed within a period of 6 months.
c) The transactions do not involve foreign exchange outlay for a period exceeding three months
d) Payment is received in time for the export leg
e) We have not availed or propose to avail EPC/RPC/PCFC or Short Term Credit by way of either
Suppliers’ Credit or Buyers’ Credit for merchanting trade or Intermediary trade transactions.
The Declaration Cum-Undertaking Under Sec 10(5), Chapter Iii Of Fema, 1999 Is Enclosed As Under:
I/we hereby declare that the transaction details of which are mentioned above does not involve and is not
designed for the purpose of any contravention or evasion of the provision of the aforesaid act or any rule,
regulation, notification, direction or order made there under. I/we also understand that if i/we refuse to
comply with any such requirement or make any unsatisfactory compliance therewith, the bank shall
refuse in writing to understand that the transaction and shall if it has reason to believe that any
contravention/evasion is contemplated by me/us report the matter to rbi. I/we also hereby agree and
undertake to give such information/documents as will reasonably satisfy you about this transaction in
terms of the above declaration. I/we further declare that the undersigned has the authority to give this
application, declaration and undertaking on behalf of the firm/company.
Thanking You,
Your Faithfully,
(Signature of the Applicant)
DATE:
(Director/Partner/Proprietor/Individual)
PLACE:
Name:______________________________
Address:___________________________
I.E. CODE:___________________________
Ver-1.3
1st-Dec- 2017
