r. ee LOLS We understand your world FORM Az (for payments other than imports and remittances covering intermediary trade) Application for FCY Cash/ FCY DD/ Outward Remittance le, demand draft / outward remittance as per details below. request HDFC Bank Ltd. to issue me/us foreign currency notes We enclase my/our cheque no. mentioned below towards equivalent INR. ‘amount, and further authorize the bank to debit my/our same account for applicable bank charges and taxes, Currency & Exchange Rate jack Equiv INR aes win Banto appesbe rate) amount Applicant Details Name Customer 10: Address: ‘Account No. PAN NoJ Form 60 (*: Cheque No. Passport Details (**): No. ‘Country: Issue Date: Expiry Date: Residential Status: (please tick the correct option) Resident Indian-| | Resident Indian -| | Non-Resident |] Foreign National Foreign National Individual Non-individual Indian (NR) holding PIO/OCI Card| _| (other than PIO/OCI) {CPaNnoie mandatary foralLRS wansactons. Sara shoul do bundbag i ernon URS taneacons where PAW ove olavalabe, FORMED \Srnandatary Wamu excoasn Ra sacs Passport Dal andar aves puposss cane of Reser fndana& al purposes care oes) Source of fund ‘Own Fund [Educational Loan Other Loan oF Borrowing Name of the financial insttution from where educational loan is obtained For issue of Foreign Currency Not Countries) of Visit Date(s) of Visit For Issue of FCY Demand Dr Payee's Name: County of Residence: Beneficiary Name “Ascount No. IBAN No Beneficiary Address Country of Residence Beneficiary Bank's ficlan 7 Beneficiary Bank & Branch Beneficiary B 'ABA Routing No. / Sor Gods Foreign Bank Charges | Remitter | Beneficiary | Full Value BSB / Branch & Transit Code () to be bore by (tick) Oo oO sees, intommediary Bank & Brane intermediary Bank's Intermediary Bank & Branch SWIFT Code ‘Additional Instructions to beneficiary, if any TE TBAN No, for remitance fo Europe, UNE, Balai, Saudi Arabia, Turkey, eel, Cater, Jordan, Pakistan & Georgia. ABA Rang Na reas USD gare USA Sort Codo in case of GBP remittance to UK; BSB Code incase of AUD remitance to Australia; Branch & Transit Code in case of CAD remifances to Canada) @Ful Valve, tthe remittance has Whether Under LRS. (YesiNo) (*) 2 be made to the beneficiary without any deductions, on payment of additional upfront charg, Purpose Code (@) Purpose Description “LRS (Liberalised Remittance Scheme) is permitted for Resident Individuals only. @ For purpose code , see overlea. It payment is for import of services (Purpose Group Nos. 02, 03, 05, 06, 07, 08, 09, 10, 11, 15, 16 or 17), please indicate: Name of the country providing ultimate services: May 2022,Declaration under Income Tax Act, 1964 | confirm that | am a resident individual as per the provisions of income Tax Act 1961 (strike out if you are a non-resident individual as per Income Tax Act, 1961 and provide your tentative taxableincome in India for the current financial year in an extra sheet) Declarations under Foreign Exchange Mana: it Act (FEMA, 1999) 1. (a) For Resident Individuals (strike out in case of other) w hereby declare that the total amount of foreign ie financial year, including this application is within the overallimitol the Liberalsed Remittance Scheme prescribed by Reserve Bank of India and certy that the soutee of funds formaking the said remittance belongs to me and the foreign exchange will not be used for prohibited purposes. Details of the remittances made/ transactions effected under the Liberalised emittance Scheme in the current financial year (April March) are as under: 'S No. Currency & Amount Name & Address of AD Branch/FFMC through which the Wansaction Date has been effected (Please add extra sheet, I required). (i) Forremittance towards maintenance of Close Relatives - (strike outifnot applicable) confirm and declare that the payee / beneficiary is closely related to me as given below, and that he/she is not resident in India, (please tick the correct lationship from options given below) Father Brother ‘Son " Spouse (incl. Step-Father) {incl Step Brother) (incl. Step-son) Son's wife Member of same Mother Sister . Daughter's HUF (ine! Step-Mother) (incl. Step Sister) Daughter Husband (ist of relatives as per provisions of Companies Act, 2013) (il) For remittance towards Gitt/donation ~ (strike out if not applicable) | confirm and dectare that the payee / beneficiary is a Berson residing outside India (Tor gills) or an organisation outside India (for donations), (*) Fortemitance touards Capital Accounttransactions (strike out not applicable | canim and declare that all my Gapiial account remittances have been and ull be made trough HIDFC Bank only AND the funds being remitted have not been borrowed from any Bank/Financial Institution, (V) Source of funds for remittance under LRS - (strike out if not applicable) | We declare that the remittance is not made from ie funds of fottery winnings or out of tncome from racingiriding etc. or any other hobby (0) For other than Resident individuals (strike out in case of Resident Individuals) “The total amount of foreign exchange purchased from or remitted through all sources in India by melus during this calendar year/ financial year, including this application is within USD. (usb. Reserve Bank of India for the said purpose. ‘only), the annual limit prescribed by 2. Foreign exchange purchased from you is forthe purpose indicated above. 3. The instructions given by mei verified andtrue to the best of my knowledge. 4, The remittance / drawl of foreign exchange is not intended and will not be used for any purpose that is prohibited or restricted under Foreign Exchange Management Act, 1998, Date. Name. Signature. (“Please note any wrong declaration made here is liable to penal action as per Foreign Exchange Management Act, 1999) Dedupe with Banned Entity List ‘Confirmed that dedype with Banned Entity List has been caried out Certificate by Authorised Dealer This i 0 certify thatthe remittance isnot boing made by /'o neigibe entities and that the remitance is incontormity with the instructions Issued by Reserve Bank of Inia under the Scheme. Signature of Bank Oficial conducting Date Dedupe with Narme & Emp Code Place Namo & Desig of Auth Official Signature with Stamp / Seal ‘Commonly Used Purpose Codes (This is only an abridged list. Please check at www [Link] / personal / form ceive or annexure for complet ist of purpose groups and codes) Resident individuals (under LAS) Capita) Account Transactions 180001 2, $0002 — Porto In 3, $0003 - Direct Investment in Equty VAWOS 4 5. 50006 ~ Purchase of immovable Property 50022 — Invosimont in DAS ‘30023 — Romitance to own Bank account Current Account Transactions 7. $0201 ~ Business Travel 8, 50303 - Travel for Pilgrmago 8. 0204 Travel for Medical Treatment Resident Individuals (under LRS) Current Account Tansactions contd Yo. $0305 11, $0806 ~ Personal and Other Travel 32, $1901 ~ Maintenance of Close Ralatives 43, $1802 Personal Gite & Donations 44, 81303 — Donation to Religious! Chantable Inst 15. 31307 — Emigration 46. 81107 Studies Abroad (incl. Corr. Courses) 17. 81108 ~ Medical Treatment (onsite / of ste) Non-Resident indians 41, $0014 -NREINAO/FCNR DepositRepat 2, §1402—NREINROIFCNR Inorost pat 3. 81412—Remit of videndincome Expats {Foreign Citzens working nina) Expats are alowed to ramit upto Net Salary earned in india, All thar romitances should be topored Under Normal Remitance (outside LRS) with purpose code $1301 ~ Family Maintenance & Savings only May 2022May 2022