Please review and sign this letter of authorization
I Mr./Ms./Mx.
holding a Citibank, N.A., Rupee Checking Account ( ) No. hereby confirm that the NRO _______________________ ___
information submitted below is true and accurate.
Kindly debit my above mentioned account and remit the funds to my NRE Foreign currency account, details of which c c
are mentioned below: (Tick above)
Beneficiary Account No. :
Beneficiary Bank & Address :
Routing code / Swift code No. : (only for foreign currency account).
Amount (In INR) :
Currency of remittance :
To facilitate the repatriation of funds. I am submitting the following documents: (Tick as applicable)
1. A2 and FEMA Declaration c
2. One original copy of Form 15CB c
3. One original copy of Form 15CA c
4. Computation of Income certified by chartered Accountant in India and proof of tax paid c
Complete copy of IT Return filed on the income which is getting repatriated c
5. Supporting documents to evidence the source of funds getting repatriated as per the checklist provided c
6. PAN Card copy c
I understand that the services herein offered by the Bank are in accordance with the regulations of Reserve Bank of India
(RBI) for Non-Resident Indian(s) and are subject to the provisions of the NRE/NRO or any other applicable scheme laid down
by RBI from time to time and any other regulations as prescribed by the Government of India and/or Foreign Exchange
Management Act, 1999 (FEMA) and/or any other applicable law/regulations.
I understand that as per FEMA Regulations, I am eligible to remit through an Authorized Dealer, an amount not exceeding
USD 1,000,000 (US Dollars One Million only) per financial year out of balances held in my NRO Account provided that where
such remittance is made in more than one instalment, the remittance of all instalments shall be made through the same
Authorized Dealer.
I further declare that the said remittance is sought to be made out of the balances held in my NRO account arising from my
legitimate receivables in India and not by borrowing from any other person or a transfer from any other NRO account and if
such is found to be the case, I will render myself liable for penal action under the Foreign Exchange Management Act, 1999.
I declare that the above transaction is in compliance with the applicable laws and regulations in India including but not
limited to the Foreign Exchange Management Act, 1999 or any rule, regulation, notification, direction or order made
(Strike off unused boxes)
I am aware that transfer of funds may be subject to the risks associated with currency exchange fluctuations and that the
amount that I may finally receive after such a transfer may be less than the amount that I had originally requested to be
repatriated. I accept and understand that the Bank is not expected to and is not responsible to take any hedging costs to
avert such losses and shall not under any circumstances be liable for any conversion rate loss or any other related costs.I
further understand that transfer of funds pursuant to my request may be delayed or may not be permitted due to any
Regulatory/ Judiciary/ Governmental stipulations or directions or orders or for any other reasons whatsoever, outside the
control of the Bank and the Bank shall not be responsible or liable for any such delay.
Note While Citibank N.A. shall make all efforts to process the transfer at the earliest, processing of such transaction may
take 20 days or more subject to all documents and information provided by account holder being complete and accurate as
per requirements.
Please Print Name Signature of the Remitter
This product/service is offered by branches of Citibank N.A., in India. © 2016 Citigroup Inc. Citi and Arc Design are registered service marks of Citigroup Inc. or its affiliates used and registered throughout the world.