Form A2
Application cum Declaration
(To be completed by the applicant)
Application for drawal of foreign exchange
I. Details of the applicant -
a. Name ____________________________
b. Address ____________________________________________
c. Account No. _____________________
II. Details of the foreign exchange required
1. Amount (Specify currency) ___________________
2. Purpose __________________________________
III. I authorize you to debit my Saving Bank/Current/RFC/EEFC Account No._________________ together with your charges and
* a) Issue a draft : Beneficiary's Name________________________
Address ________________________________
* b) Effect the foreign exchange remittance directly -
1. Beneficiary's Name _________________________________
2. Name and address of the Bank _______________________
3. Account No. ____________________
* c) Issue travellers cheques for _____________________________
* d) Issue foreign currency notes for _________________________
• (Strike out whichever is not applicable)
Signature
Declaration
(Under FEMA 1999)
I, _________________________ declare that -
* 1) 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 ________________________
___________________________________________________________only) the annual limit prescribed by Reserve Bank of India for the said purpose.
* 2) Foreign exchange purchased from you is for the purpose indicated above.
• (Strike out whichever is not applicable)
Signature
Name _____________
Date :