Declaration-cum-Indemnity

To:
The Branch Manager,
_______________ Branch,
HDFC Bank Ltd (“HDFC Bank”)

I/We ……………………………………………………….residing at ___________________,

here by request you to remit USD/……………………………to …………………………………
……………………………… (Beneficiary Name) for ……………………………………………
…………….. (Purpose) from my/our account bearing no………………………………………………

I/We declare that the said remittance is for bonafide permissible purpose as per Liberalised
Remittance Scheme of Reserve Bank of India, and not for trading in foreign currency and/or for
remittances towards margin money for trading on overseas exchanges or for any purpose/s
prohibited by RBI under the Liberalised Remittance Scheme or under the provisions of the
Foreign Exchange Management Act, 1999.

I/We agree and acknowledge that the remittance as requested by me/us will be processed by you
based on my aforesaid representation and declaration, in good faith and believing it to be true.

In consideration of the above , I/We hereby irrevocably indemnify and shall at all times keep
HDFC Bank and its officials indemnified, saved and harmless from and against all actions
including but not limited from the regulators/enforcement authorities, , claims, losses, damages,
costs, liabilities, charges and expenses incurred, suffered or paid by HDFC Bank or required to be
incurred, suffered or paid by HDFC Bank and against all demands, actions, suits or proceedings
made, filed or instituted against HDFC Bank in connection with or arising out of or relating to the
Bank remitting such amounts as requested by me/us

Signature of the applicant

Name:
Date: