FORM A2 AD Code No._____________________________ (for payments other than imports and Form No._________________________________ remittances covering intermediary trade) (To be filled in by the Authorised Dealer) Serial No.________________ ________________ (For use of Reserve Bank of India) Application for Remittance Abroad Currency ___________ Amount_____________ Equivalent to Rs.___________________________ (To be completed by Authorised Dealer) I/We wish to purchase/transfer ____________________________________________________ (Name of currency and amount in words) through_____________________________________________________________for payment (Name and address of Authorised Dealer) to ___________________________________________________________________________ (Name and address of the beneficiary) by remitting the amount / by credit to the account of___________________________________ (Full title of the account & country of non-resident bank and name of AD with whom account is maintained) _____________________________________________________________________________ for the purpose indicated below: (Remitter should put a tick ( ) against an appropriate purpose code. In case of doubt/difficulty, consult your banker.) Code Purpose Code Purpose Capital Account Transactions Insurance S001 Investment in shares abroad by residents S501 Life insurance premium S002 Investment in Debt Securities abroad by residentsS502 General insurance premium S003 Investment is branches/subsidiaries abroad by S503 Reinsurance premium residents S504 Insurance commission S004 Investment in real estate abroad by residents S510* Other insurance payments S005 Repatriation of foreign investment in shares Other Services S006 Repatriation of foreign investment in Debt SecuritiesS601 Postal/Telecom services S007 Repatriation of foreign investment in subsidiaries/S602 Projects abroad branches S603 Band charges/commission S008 Repatriation of foreign investment in real estate S604 Soft/Hardware consultancy, services S009* Loans to non-residents S605 Subscription to periodicals, Correspondence courses S010* Repayment of LT/MT loans S606 Computer and IT services S011* Repatriation of NR deposits S607 Royalty, License fees S012 Repayment of ST (6 m. to 1 Yr.) Loans S608 Professional service, Technical fees S013 Repayment of loans/ODs by banks S609* Refunds and rebates on trade S014 Notional sale for credit to NRI deposits S610* Other remittances S015* Other capital account payments Government, Not included elsewhere Other import payments not covered by form A1 S701 Maintenance of Indian Embassies S103 Imports by diplomatic mission S702 Remittance by Foreign Embassies S104 Imports under intermediary trade Transfers Travel S801 Foreigner's family maintenance S301 Business travel S802 Private gift/donation S302 Travel for Medical purpose S803 Grants/donations to charity by Govt S303 Travel for education S804 Contribution by Govt. to international institutions S304 Basic Travel Quota (BTQ) S810* Other transfers S305 Travel for pilgrimage Income S310* Other travel payments(Including credit card) S901 Interest on NRI deposits Transportation S902 Interest on loans S401 Shipping transport - Remittance by fgn. cos. S903 Dividends, profits S402 Air transport - Remittance by fgn. cos. S904 Interest on debentures/bonds S403 Shipping transport - Remittance by Indian cos. S905 Interest on ODs in Nostro A/c. S404 Air transport - Remittance by Indian cos. S906 Salary of Non-residents S405 Freight on imports S910* Other income S406 Freight on exports S407 Charter hire charges (Airline cos.) S408 Charter hire charges (Shipping cos.) S409 Booking of passage in foreign countries S410* Other transportation (e.g. demurrage, etc.) *Please give full details_________________________________________________________ _________________________________________________________ I / We hereby declare that the statements made by me / us on this form are true and that I / we have not applied for an uthorisation through any other bank. I / We declare and understand that the foreign exchange to be acquired / payment to be made by me /us pursuant to this application shall be used / made by me / us only for the purpose for which it is acquired / to be made and that the conditions subject to which the exchange/permission is granted will be complied with. I/We desire to travel to __________via___________for the purpose of___________________ Passage has been booked through_________________________________________________ (Name of airline/shipping co. or passage agent) ____________________The date of departure is ______________The exchange is required in the form of Currency Amount Notes & Coins _______________ ______________ TCs _______________ ______________ Draft _______________ ______________ Letter of Credit _______________ ______________ Total _______________ ______________ Name of Applicant (s) ______________________ Nationality of Applicant (s) _____________ Address of Applicant (s)_________________________________________________________ _________________________________________________________ Date ----------------- Signature of Applicant(s)/Authorised Official (Space for comments of the Authorised Dealers) While forwarding the application to Reserve Bank of India for approval, reference to ECM paragraph / AD circular in terms of which the reference is made should invariably be cited.) Approval for similar remittances was obtained from the Reserve Bank of India vide permit No. _________________ dated _________________. ___________________________________ (Stamp and Signature of Authorised Official) Name & Designation ................ Name & Address of Authorised Dealer ........ Date ______________ Certificate to be furnished by Authorised Dealers (Applicant's Banker) We hereby certify that A. the remittance has been made In terms of authority delegated to authorised dealers vide paragraph __________ of the Exchange Control Manual and / or AD Circular No. ______________________ dated __________________________ or In terms of Reserve Bank Permit No. ________________ dated ___________________ B. all the Exchange Control regulations applicable to the remittance have been complied with. C. documentary evidence in support of the payment has been verified. D. payment to the beneficiary has been/will be made through______________________ _____________________________________________________________________________ _ (Name and address of the designated bank in ACU member country) _______________________________________ (Stamp and Signature of Authorised Official) Name & Designation ................ Name & Address of Authorised Dealer ........ Date: ____________
