Fillable I/We (Name of applicant remitter)

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I/We (Name of applicant remitter)

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I/We
(Name of applicant remitter)
(Name of AD branch)
PAN No.
Address :
To debit my Savings Bank/Current/RFC/EEFC A/c. No. together with their charges and
authorise
*(Strike out whichever is not applicable) for the purpose/s indicated below.
2) To be filled by residents only if the remittance is made under LRS
Whether under LRS
(Yes/No)
As per the Annex
VER 1.7/FORM A2/WPC/03-19
*
*
*
Issue foreign currency notes (Specify currency) for:*
Amount (specify currency) :
Name of the country providing ultimate services:
Remitter should put a tick (√) against an appropriate purpose code. In case of doubt/ difficulty, the AD bank should be consulted.
3) Payment for import of services (Purpose Group Nos. 02, 03, 05, 06, 07, 08, 09 10, 11, 15, 16 or 17), please indicate:
Signature of the Applicant
I, , 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 as per the extant FEMA Regulations and
certify that the source of funds for making the said remittance belongs to me and the foreign exchange will not be used for prohib-
ited purposes / Foreign exchange purchased from you is for the purpose indicated above.
Details of the remittances made/transactions effected under the Liberalised Remittance Scheme in the current financial year
(April- March) ...
Date Amount
Name and address of AD branch/FFMC through
which the transaction has been effected
Certificate by the Authorised Dealer:
This is to certify that the remittance is not being made by / to ineligible entities and that the remittance is in conformity with the
instructions issued by the Reserve Bank from time to time under the Scheme.
Name and designation of the authorised official Stamp and seal
2019
Acquisition of non-produced non-financial assets (Purchase of intangible assets like
patents, copyrights, trademarks etc., use of natural resources) – Non-Government
Acquisition of non-produced non-financial assets (Purchase of intangible assets
like patents, copyrights, trademarks etc., land acquired by government, use of
natural resources) –
Advance payment against imports made to countries other than Nepal and Bhutan
S0101
Payment towards imports- settlement of invoice other than Nepal and Bhutan
S0102
Imports by diplomatic missions other than Nepal and Bhutan
S0103
Goods acquired under merchanting / Payment against import leg of merchanting trade*
S0108
Intermediary trade/transit trade, i.e., third country export passing through India
S0104
S0109
01 Imports
02
00
Construction
Services
03
05
06
07
08
09
10
11
12
16
17
Capital transfers (Guarantees payments, Investment Grand given by the government
/international organisation, exceptionally large Non-life insurance claims) – Government
Capital transfers (Guarantees payments, Investment Grand given by the Non-government,
exceptionally large Non-life insurance claims) – Non-Government
Opening of foreign currency account abroad with a bank
Payments made for Imports from Nepal and Bhutan, if any
Payments for surplus freight/passenger fare by foreign shipping companies
operating in India
Other Business
Services
Charges for
the use of
intellectual
property n.i.e
Govt. not
included
elsewhere
(G.n.i.e.)
Maintenance
and repair
services n.i.e
Manufacturing
services
(goods for
processing)
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IWe (Name of applicant remitter)

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Completed 8 November 2021

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