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Annexure III

We, ------------- address ------------- ,do hereby agree to report Liberalised Remittance Scheme
(LRS) transactions vide our registered e mail ID -----------(before 4:00PM) on daily basis (as per
prescribed format) for further reporting to RBI.

We confirm that all transactions processed are in compliance with FEMA guidelines and we
undertake all responsibility of data and submitted report. We also confirm that data submitted to
Axis Bank Limited, TARNAKA Branch is not given to any other AD Bank or any other branch
of Axis Bank Limited for submission to RBI.

Further, we also confirm that only those transactions which have not been handled through
banking platform like sale of foreign currency (cash) to travellers (under LRS) are being
reported.

Thanks & Regards

Authorised Signatory

Date :

Place :

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