To be printed on Company Letter Head

CUSTOMER DECLARATION FOR THIRD PARTY REMITTANCES

DATE :

To,The Chief Manager,

Union Bank of India,
Goregaon East Branch

Dear Sir,

Sub :Payment of _______________________ received from ____________________ -..

For no proper banking/system towards realization of Export Bill,Invoice number____________

We refer to the above payment and request you to realize the said bill submitted to you.

Reason for third party remittance :

Reason for not declaring the name

of third party remitter in the
EDF/SDF/Shipping bill at the time
of shipment
Relationship between Buyer and
remitter

Basis of such relationship(as above)

We further declare that the payment from the third party is made in line with the local regulations
of the remitter's/exporter's country such as taxation, foreign exchange trade regulations, etc. all the
supporting documents for the same have been taken by us.

Thanking you,

Yours faithfully.

For Company Name

Authorised Signature
Encl:Email/letter from remitter/buyer