* d) Issue foreign currency notes for __________________________________ Amount (specify currency) __________________________________ * (Strike out whichever is not applicable) for the purpose/s indicated ____________________________ Sr. No. Whether under LRS Purpose Code Description (Yes/No) As per Annex Remitter should put a tick (√) against an appropriate purpose code. In case of doubt/ difficulty, the AD bank should be consulted). Declaration (Under FEMA 1999) 1. # I, _______________________________________________________ Name), hereby declare that the total amount of foreign exchange purchased from or remitted through, all sources in India during the financial year including this application is within the overall limit of the Liberalised Remittance Scheme prescribed by the Reserve Bank of India and certify that the source of funds for making the said remittance belongs to me and the foreign exchange will not be used for prohibited purposes. Details of the remittances made/transactions effected the Liberalised Remittance Scheme in the current financial year (April- March) ..…….. Sl. No Date Amount Name and address of AD branch/FFMC through which the transaction has been effected 2. # The total amount of foreign exchange purchased from or remitted through, all sources in India during this calendar year including this application is within USD _______________________ (USD ____________) the annual limit prescribed by Reserve Bank of India for the said purpose. 3. # Foreign exchange purchased from you is for the purpose indicated above. # (Strike out whichever is not applicable) Signature of the applicant (Name) Date:
* d) Issue foreign currency notes for __________________________________ Amount (specify currency) __________________________________ * (Strike out whichever is not applicable) for the purpose/s indicated ____________________________ Sr. No. Whether under LRS (Yes/No) Purpose Code Description As per Annex Remitter should put a tick (√) against an appropriate purpose code. In case of doubt/ difficulty, the AD bank should be consulted). Declaration (Under FEMA 1999) 1. # I, _______________________________________________________ Name), hereby declare that the total amount of foreign exchange purchased from or remitted through, all sources in India during the financial year including this application is within the overall limit of the Liberalised Remittance Scheme prescribed by the Reserve Bank of India and certify that the source of funds for making the said remittance belongs to me and the foreign exchange will not be used for prohibited purposes. Details of the remittances made/transactions effected the Liberalised Remittance Scheme in the current financial year (April- March) ..…….. Sl. No Date Amount Name and address of AD branch/FFMC through which the transaction has been effected 2. # The total amount of foreign exchange purchased from or remitted through, all sources in India during this calendar year including this application is within USD _______________________ (USD ____________) the annual limit prescribed by Reserve Bank of India for the said purpose. 3. # Foreign exchange purchased from you is for the purpose indicated above. # (Strike out whichever is not applicable) Signature of the applicant (Name) Date:
outwar-remittance-non-import.docx