(To be printed on White paper) A.D.Code No._______________________ Form No.___________________________ (To be filled by authorised dealer) FORM A3 .......................................... (To be completed for transfer of rupees Serial No.__________________________ from/to the account of a non-resident (For use of Reserve Bank of India) bank other than for transactions with the public in India) We have effected/seek permission to effect the following transfer. _____________________________________________________________________________ _ From the account of_____________________________________________________________ (Full title of account of non-resident bank debited, stating ____________________ at ______________________________________________________ country of residence) (Name of authorised dealer with whom account is kept) for transfer to__________________________________________________________________ (Full title of account of non-resident bank credited, stating ____________________ at ______________________________________________________ country of residence) (Name of authorised dealer with whom account is kept) Amount Rs.____________ ______________________________________________________ (in figures) (in words) The purpose of the transfer is_____________________________________________________ _____________________________________________________________________________ We certify that Exchange Control regulations relating to the above transfer have been complied with. Similar transaction was approved by th Reserve Bank vide approval No.................... dated ............ Date:.......... ................................ ......................... ........Stamp (Signature of Authorised Official) Name ................................ ......................... Designation................................ ..................... Name and Address................................ .......... of Authorised Dealer................................ ...... _____________________________________________________________________________ _ __ NOTES: 1. Where accounts of non-resident banks are put in funds against purchase of foreign currency, the transferor portion of the form may be completed indicating merely "Against Purchase of __________ __________" (currency) (amount) 2. Where debits to accounts of non-resident banks are made towards sale of foreign currency to them, the transferee portion of the form may be completed indicating merely "Against sale of ___________ ____" (currency) (amount) 3. While forwarding the application to Reserve Bank for approval, reference to Exchange Control Manual paragraph/AD circular in terms of which the reference is being made should invariably be cited.
