Annexure-I
Department of Posts, India
Application form for Remittance foreign countries (MVIDESH)

01. Remittance
Country
Currency
Value of remittance In fig (In Foreign Currency)
Value in words :
02. Commission
Paid by Remitter
Paid by Payee
03. Purpose of Remittance
Studies abroad
Medical Treatment abroad
Family maintenance
Travel/Tour
04. Mode Of Payment
Cash
SB a/c
05. Sender Details
Name
Address
Mobile/Phone No.
E mail ID
Bank /POSB A/c No.
06. Beneficiary Details
Name
Address
Postal code
IBAN No.
SWIFT code
Bank A/c No.
Beneficiary Bank name
07. Nationality
Indian
NRI
08. Source of Funds
Salary
Business
Pension
Interest
09. Occupation
Employed
Retired
Self Employed
Others
10. Whether the remitter is politically Exposed Person(PEP) as per RBI guidelines
Yes NO
11. Remittance information
Date:- Signature of the remitter
Guidelines tcustomers tfill up the Application for Remittance
(MVIDESH)
General Instructions:
Please clearly indicate all columns in “ BOLD LETTERS “ only.
Please tick()the check box, for option is tbe selected in the application form.
Please confirm before fill up the application if you have any doubt in the application.
Guidelines for specific Columns.
Column N1: Please write ‘Name of the country’ for which amount is tbe remitted in country column.
Write Currency code (Eg. US Dollar, Euro, INR) against the currency column.
Indicate the value of remittance in foreign currency like USD in the remittance
column.
Column n2. Indicate the commission option. Under commission paid by the remitter, the commission will be calculated based on the following slab.
USD 100-1000 USD 12 + Service Tax
USD 1001-3000 USD 20+ Service Tax
USD 3001-5000 USD 25 + Service Tax
Under commission paid by beneficiary option the commission will be calculated based on the following structure in addition Rs 150/- as service charge.
USD 100-500 USD 6
USD 501-1000 USD 8
USD 1001-2000 USD 12
USD 2001-3000 USD 15
USD 3001-4000 USD 18
USD 4001-5000 USD 20
Column 4: The mode of payment can be through cash or through POSB account
Column N6: IBAN number indicates International Bank account number. IBAN is compulsory for remittance European countries.
indicate SWIFT Code under swift code column.
Bank account number indicates the beneficiary bank account number.
Column 10:
As per RBI directives, a "Politically Exposed Person" is a person whperforms important functions for the state. If the remitter belongs tany of the following categories he will be treated as "Politically Exposed Person"
Head of state, government and cabinet minister /Influential functionary in nationalized industries and government administration/Senior judge/Senior party functionary Senior and / or influential officials, functionaries and military leaders and people with similar functions in international or supranational organizations/Members of ruling royal family/Senior and / or influential representatives of religious organizations if these functions are connected with
political, judicial, military or administrative responsibilities.
Column 11:
Any information tbeneficiary related tremittance may be noted (not more than 50 characters)
Eg. Invoice Number and date of estimation from university/ Hospital/ Tour agent may be noted.