FORM A 1 (For Import Payment only) Application for Remittance in Foreign Currency Amount Remitted . Currency
Serial No. .
Amount
(For use of Reserve Bank of India) A.D. Code : 0001188-2900009
Equivalent to Rupees .
Form No. ..
(To be completed by authorized dealer)
(To be filled by authorized dealer)
I/We wish to purchase (Name of Currency) Through
(Amounts in Words)
State Bank of India, Ring Road, Lajpat Nagar, New Delhi- 110 024, INDIA
for payment to
..payment (Name and address of the beneficiary of the remittance) Import into India detailed below:
IMPORTERS CODE NO. . Details of goods Imported or to be imported into India Section A: Import Licence/Open General Licence Particulars O.G.L. /.. Number
1
2
..
Schedule
Serial Number
Part
Import Licence
Prefixes
Licence No.
Date of Issue
Suffixes 1
2
3
4
5
e t a D
h t n o M
r a e Y
Date of Expiry
e t a D
h t n o M
r a e Y
Face Value of Licence
Amount to be endorsed (in Rs.) @
Balance outstanding on the Licence after the remittance
@ Actual amount endorsed in rupees against each licence involved, should be stated under this column Note : If more than one licence li cence is involved, particulars of all licences should be furnished. If the space is inadequate a separate statement may be attached. The amount utilized against each licences should invariably be indicated.
Section B: Import Particulars Invoice Details
No. and date
terms c.i.f., f.o.b., c.&f. etc.
Currency
Amount
Quantity of Goods
Description of Goods
BTN Classification
Country of Origin of Goods
Country from which goods are consigned
Mode of shipment (air, sea, post, rail, river, transport etc.)
Date of shipment (if not known approximate date)
Section C: Other Particulars 1.
Details of forward Purchase Contract, if any, Booked against the import
2.
.
.
.
No. & Date of
Currency & amount
(Balance under
Contract
Contract
the Contract)
If remittance to be made is less then invoice value,
..
reason therefore (i.e. part remittance, installment etc.)
.. ..
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 authorization through any other bank. I/We declare and also understand that the foreign exchange to be acquired by me/us pursuant to this application shell be used by me/us only for the purpose for which it is acquired and that the conditions to which the exchange is granted will be complied with. Name of Applicant (s)
(BLOCK CAPITAL)
Nationality of Applicant .. (BLOCK CAPITAL)
Address of Applicant (s)
.. ..
(BLOCK CAPITAL)
.. .. ..
Date (Signature of Applicants) Note: For remittance covering intermediary trade. Form A2 should be used.
Declaration to be furnished by Applicant (s) I/We declare that (a)
the goods to which this application relates have been* Imported into on India on my/our/ own account*
(b)
the import is on behalf of @ .*and
(c)
the invoice value value of of the goods which is declared on this form is the real value of the goods imported*
Will be* __ into India,
to be imported* if the import has been made
I/We attached the relative Customs stamped Exchange Control copy of bill of entry*
If the import is to be made
I/We undertake to produce within three month to be authorised dealer the relative custom-
Post parcel wrapper (for imports by post)* stamped exchange control copy of bill of entry*______________________________________ (for import by post)* Strike out item not applicable @ Where the import is on behalf of Central/State Government Department or a company owned by Central/State Government/Statutory Corporation, Local Body, Body, etc. the name of the Government Department, Corporation etc. should be stated.
. (Signature of Applicant (s)
Date
Space for commencements of the authorised dealer While forwarding the application to the Reserve Bank of India for approval (reference to Exchange Control Manual paragraph/A.D.Circular in terms of which the reference is made should invariably be cited. If any remittance application on account of the same import was referred to Reserve Bank earlier, reference to the last correspondence/approval should also be cited.)
. (Stamp and Signature of Authorised Dealer)
Date
Certificate to be furnished by Authorised Dealer (Importer's Banker) We hereby certify that (a) This payment payment is Put a tick ( ) in the relevant block
(i) (ii) (iii) (iv)
an advance remittance in retirement of bills under Letter of Credit opened through us against documents documents received through our medium for collection on account account of documents documents received received direct direct by the applicant/s against undertaking undertaking furnished by the latter to submit CustomsCustomsstamped Exchange Control copy of Bill of Entry of Post Parcel/courier wrapper within three Months (v) on account of documents received direct by the applicant/s against Customs-stamped Customs-stamped Exchange Control copy of Bill of Entry/post parcel/courier wrapper (attached) submitted submitted by the latter vi) ____________________________________________________________________________________________________
(Any other case, to be explained) (b) all the Exchange Control regulations regulations applicable to the remittance have been complied with (c) the payment to the supplier of the the goods has been* made through_____________________________________________________________ through_____________________________________________________________ Will be* (Name & Address of the foreign bank) We also certify/undertake that the relevant Customs-stamped Exchange Control copy of Bill of Entry or post parcel wrapper shall be verified by us w ithin three months (vide certificate (a)(ii) and (iii) above) has been verified (vide certificate (a) (v) above) shall be obtained from the applicant/s and forwarded to the Reserve Bank of India within three months (vide certificate (a) (i) and (iv) above) Strike out item not applicable y y y
y
Name: Designation: Date ..
(Stamp & Signature of Authorised Dealer)
