To,

The Branch Manager,

Union Bank of India,
Race Course Branch, Rajkot

Dear Sir,

Request for Purchase of Foreign Currency for making payment for Imports

I/We request you to allow us to purchase Foreign Currency from your Bank towards Advance Payment for
Import/Export Payment as per Foreign Trade Policy/FEMA, the details of which are as under:

1. Details of Importer :
Name of Account : NOVA INTERNATIONAL

Account No. : 536 90 10 100 50 138

IE Code No. :

2. Details of Foreign Currency to be : ____________________ (Currency) _________________ (Amount)

Purchased

3. Details of Goods to be imported :

Name of Goods : ________________________________________________________

ITC (HS) Classification No. :________________________________________________________

Country of Origin : ________________________________________________________

Whether goods are under OGL/

Import License : ________________________________________________________

If under License, details thereof : License No. ______________________________________________

Expiry Date of License ____________________________________
Face Value of License ____________________________________
Amount to be endorsed ___________________________________

4. Details of Beneficiary
Name : ________________________________________________________

Full Address of Beneficiary : ________________________________________________________

________________________________________________________

___________________________ Country of Beneficiary: __________

Account Details : Account No. ______________________________________________

Name of Bank, Branch & Address _____________________________

________________________________________________________

________________________________________________________

SWIFT Code _____________________________________________

Intermediary Bank Details(if any) : Name of Bank, Branch & Address _____________________________

________________________________________________________

________________________________________________________

SWIFT Code _____________________________________________

 (P.T.O)

I/We hereby declare that the statements made by me/us on this form are true and that I/We have not applied for an
authorization through any other Bank.

I/We declare and also understand that the foreign exchange to be acquired by me/us pursuant to this application
shall be used by me/us only for the purpose for which it is acquired and that the conditions to which the exchange is
granted will be complied with. We also declare that all the Exchange Control Regulations applicable to be remitted
have been complied with and we shall submit Customs-stamped Exchange Control Copy of Bill of Entry, Post
Parcel/Courier Wrapper within three months (If not already submitted).

I/We also declare that as per extant Foreign Trade Policy, the goods covered by the attached Purchase Order can
be imported without any restriction and the items are not in the negative list in terms of various provisions of Chapter
2 of Foreign Trade Policy 2015-2020.

I/We hereby declare that the transactions, the details of which are specifically mentioned in the Schedule hereunder
does not involve, and is not designed for the purpose of any contravention or evasion of the provisions under
Section 10(5), Chapter III of Foreign Exchange Management Act, 1999 or by any rule, regulation, notification,
direction or order made there under.

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 also understand that if I/We refuse to comply with any such requirements or make only unsatisfactory
compliance therewith, the Bank shall refuse in writing to undertake the transactions and shall, if it has reason to
believe that any contravention/evasion is contemplated by me/us report the matter to Reserve Bank of India.

I/We further declare that the undersigned has/have the authority to give this declaration and undertaking on behalf
of the firm/company.

__________________________________________
(Signature of Importer / Authorised Official)

Name & Address of the Importer

__________________________________________

STAMP __________________________________________

Place: ________________________ __________________________________________

Date: ________________________ __________________________________________