Note: Correspondent Bank charges borne by (select any one) [ ] Beneficiary (BEN) [ ]

Remitter(OUR) []Sharing(SHA):- Please tick on OUR.

Application cum Declaration for Remittance / Purchase of Foreign

Exchange under the Liberalized Remittance Scheme.
(To be completed by the applicant)

I. Details of the applicant

a. Name Gokul Krishnan

b. Address APPLICANT ADDRESS

c. Account No. APPLICANT ACCOUNT NUMBER d. PANS No APPLICANT PAN NUMBER II. Details of

the foreign exchange required

1. Amount (Specify currency) EURO 250, 00 2. Purpose FOR STUDY PURPOSE CODE S0305

III. Source of funds: SAVING ACCOUNT / CURRENT ACCOUNT

IV. Nature of instrument

Draft……………………….. Direct remittance YES

V. Details of the remittance made under the Scheme in the financial year (April- March) 2020-

21 Date: ______ Amount: 250, 00 EURO

VI. Details of the Beneficiary

1. Name: WBS TRAINING AG

2. Address: Lorenzweg 5, 12099 Berlin

3. Country: Germany

Beneficiary Bank Details

4* Name and address of the bank: COMMERZBANK AG

5*.Swift Id: BIC: DRESDEFF600 Routing / ABA / SORT …………..

6* Account No / IBAN No.: DE87 6008 0000 0233 2747 00

(* Required only when the remittance is to be directly credited to the bank account of the beneficiary)

This is to authorize you to debit my account and effect the foreign exchange remittance/issue a draft
as detailed above. (Strike out whichever is not applicable)
Signature of the applicant

Declaration

1
I, APPLICANT NAME hereby declare that the total amount of foreign exchange purchased from or
remitted through, all sources in India during the financial year as per item No. V of the Application, is within the
limit of USD 2,50,000/-(US Dollar Two Lac Fifty Thousand only), which is the limit prescribed by the Reserve
Bank for the purpose and certify that the source of funds for making the said remittance belongs to me and will not
be used for prohibited purposes.

Signature of the applicant

Name:

Contact no: Email:

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~ EXTRACT OF SECTION 2(77) OF THE COMPANIES ACT, 2013

Meaning of “relative”

A person shall be deemed to be a relative of another if, and only if,-

(a) They are Members of a Hindu undivided family; or

(b) They are husband and wife; or
(c) The one is related to the other in the manner indicated in Schedule IA.

SCHEDULE IA

LIST OF RELATIVE (kindly mark  whichever is applicable)

Father: Provided that the term ‘Father’ includes step-father. 

Mother: Provided that the term ‘Mother’ includes step-mother  Son:
Provided that the term ‘Son’ includes step-son.  Son’s wife 
Daughter 
Daughter’s Husband. 
Brother: Provided that the term ‘Brother’ includes step-brother  Sister:
Provided that the term ‘Sister’ includes step-sister 

Signature of the applicant

Name:
Contact no: Email: