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 (ü) 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 residents S502 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 Securities S601 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 authorisation 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: ____________
