Retail Outward Remittance Application cum A2 Form for purchase of Foreign Exchange fly AXIS BANK ‘Are youn Axis Bank customer? | Yes| | No CastomerlO- I ew TT Nome I I I Cumen tatus Reine nae 10/0¢1 Forsgn National "a ar Seis ‘Rese de mene fo NON Reset nda fyeu eran NPD /OCI Cee ene ee 1D proof attached” ‘adhaar Card Passport Voter 10 Delving License aN ‘Address proof attached aaae Crd Passport Voter tO Driving License NREGA Job Card ‘Mother's Malien Name I [TTT fatter spouse's Name I Gender [| Male (Female others Married [| Yes [| No Date of Birth l emat | | ol I I ooo Phone No. 191 Coo Occupation Code |_| Slaied |_| Setemployed Business Retired student | |Housewire |_| Others subcode || Desctiotion I Tax Residence Jurisdiction sterhants I "PAN sand fests Eee ican Eee nn [Nature of Instrument Foreign Currency Demand Draft Telegraphic Transfer FCY Notes Traveller's Cheques Select Currency (FCvy USD Dole FUR Euro} PY (Yen) BP (Pound) CHE (Sniss Franc) for Remittance ‘AUD (Aus Dollar) NZD (NZ Dollar) ‘CAD (Canadian Dollar} Other ‘Amount in FCY (Foreign Currency) or, Taam ‘Amount in INR inWords {If Fixed INR amount would be converted to FCY at the applicable rate. The commizslon, Forelgn Conversion Tax, Service Tax, Correspondence Bank Charges ould be recovered in addton to the fixed INR amount. ‘Sources of Funds Salary Business Income Rent Income Other Rate to be booked on FX Reta Platform CCH Customer 1D Debit Authority: | / We authorize you to debit my / our Account Number toeffect the Foreign Exchange Remittance /Isue a Draft /FCY Notes / Travellers Cheques as detailed above (strikeout whichever snot applicable alongwith your applicable charges (Commission, Foreign Conversion Tax, Service Tax and Correspondent Bank Charges) to my / our ‘Account Number || (other than the operative account) WhetherunderLRS [| Yes |_| No Purpose Code Description _ Name of the Country Providing Ultimate Services? ‘Your Account Number CLO “Your banch SC {erteconct en neon le cen ar) Family maintenance: Relationship b/w remiter 6 beneficiary: “Travel for Holday Tap / Pllrimage / Medical / Immigration / Employment Business Travel /Eaucation Travel Fath Mother" Sonswite | Son" ee name I co te) Dauriters other ister" Traveller's Passport No Daveh brs Brother Sister" Traveller's Passport Ne oo Spouse Member of HUF tater etal “nes prep eat Sef Eaton Tt nls umber Hla T line Medel / mignonRetail Outward Remittance Application cum A2 Form for purchase of Foreign Exchange y BANK Ean Beneficiary Name I I I I Benet Coney I entry ess I Correspondent Bank Detals I Benefiary Bank I Beneficiary Bank Adress Lu LI Beneciary Bank's Country CLO oO Benenclary Account I ener Bank SWIFT Code I I CECH uo IBAN (or reitaren to UX farape L111 oO Bain Su fab snd URE) Sort Code (tor remittance to UK) I ‘Transit Number (for remittance to Canad} [TI se Code torremitanceto Autrata) [|| | Routing Nunber (fr reitance to USA) LT Correspondent Bank Charges to be borne by. Beneficiary (BEN) Remiter(OURS) Shared (SHA) Declarations Details of the remittance made under the Scheme in the current Financial Year (April - March) 20___- 20. edn ee FAO ‘oto aan it ae te 1. {/vesetnatyagean tater hematin onary yt an ti etn 1 Tete anette eg prnston sre rss suet eae erg espe hn 5 2S00 (0 Wea Fy Theron em ‘eprther trans bot efor ta prom rant aa 2 ene cy ade ma De nities wean ean nga bt rend Bs 4 howe ol Neng ing nerd ee Shee Cpe a ti ‘noah et eee Sheree ese Foard a arrears re mse vat rear ete Vie dsr it ener retiree ecole encour pekinese ated shown {tamara pron dn eager nl rig oe nt en ig pa ct ines an a ey a by she ey eter ac Cac ato as i lon power lea eee pl ct a ey de orton eae eda pe 2. Toronto tot cman tap oie el ed icy ob EP ry ‘oer trating eso sone yam ty got ape shat bral encom cee an meee ero henae ean nt eu Cans el ent wn taney sete a ana oe eee Ine saunter coe a nage wed ca a hb Ape ny eno esa neh ote a at Iesonea atectntsnine mahi Peel streetscene ‘Skt ent eta as ton ttn of caf Bat lee a ad eth ey ay san be ‘Saito om ponerse ntse tatu saline sana hae bade ocak snes rena fess ‘toxins ern cr sn ue beeen en othe reo tet of see on te om beet i ie lg ener Crntemrahemturori rong obiertetonr angel nomen tere te rare cane lteter era tenecre sete ten re ae at ‘Sttane Sats seta Sate pty nelson see cbse anon ope ac sen Sa od 9 eae season Coe 0 satay eon oremrine Set teevet eben thn ate spe gnc eran bg “rom td ye th nd Sco nd Scot ok range ta dt 20 “arena et ny nn et ind esi ph er al can ero Bin by eR br LiWeagett master mo seg ft rocoto et tion nd orgs lara si |/ eae ‘eon comacton neces re Do ‘natunaindurg evs sca hoary econo ott 9. Vetere at he undies eth top eaten antag ont mmo eb whe helen eran ane sid 122 /Mmcoten htemtne set erm migcatseeve eine erent 12. (When tenes pC encom er day a 15. Weetstreiic tC et es eine cert ec Ate uk oe ATF Norco Canaan 17. 1/ eam at pane noun ee rer ty eet yon na a ai erg ng a Dane Tang arsenic eset emis neoprene seats se Pogntrgompnet fe orPneabrgtoasn crepe eg ow aor Rm Sree ent Sernieathentnl ganna beep Strsarecto mn Coreicate by the Authored Dealer Tit eto carat thatthe remitanes ent beng made by /olnebi ented ta the emitane iin confi wth the inetruons sted hy he Reserve Bank tram tit tin ner the Scherer NT Customs, OSV KC das donb Branch / Operation Head AML degen argh Cah ai Fansaetone Name a designation of he Autodsed Off: Pace star. Seal na Sarat cera that hav vei the Castes senate apr Bank records ad etane the cna ofl the scanned docieants and fx submited bythe ee forthePoe en 41. We request As Bank to send outward remitancel) / sue Demand Ort (s) / Forex Caden behaf of our customer (Appleant) sper deta submited inthis ‘Aplin Frm. This Aopen refred to os Bak bass the Real Agrerent cum Inde executed Deven Rs Bark aus ad ‘Ate tame andcontons tatedinthe si Refral Agreement cum inert salbe appeal tots renitance/ pcos arsactin. The Aopkcantshl sub al he equred EY another neces documents a equted by Als Bank The ind fo the alt rertance/purchvetaacton) hal be tangs recy by the Applicant to ‘is Bank remitance/ urea tancactois ae east he Asplcnt nd that Ae Bak nt under ebgaton overly the veracy cf he statements 3 above and As Bank shat not beheld ate for any discrepancies or roneous sates a contained erin and itt cnt hat fis Bank shllatndindefed at al nes or sn los ncuret by As Bank on account of any riseresntten by us bythe Applicat ee For remittance of Assets: (The source of funds for the present remittance is (tick and fil the appropriate options) Sale proceeds of immovable property in India. Amount realized INR co Sale proceeds of other assets (please specify nature of asset) || | | | | ‘Arnount realized INR CLI Maturity proceeds of fixed deposits. Amount realized INR. Ai) Mode of Acquisition of the assets (tick the appropriate options) ‘Outof own funds when |/ We (Out of own funds when |/ We (ut of inheritance / legacy was / were person (s) resident in India was / were person(s) resident in india For remittance of Current Income: Source of funds forthe present remittance are (tick the appropriate options) Interest on Savings Bank a/é |_| Intereston FDs |_| Dividend on shares / Mutual Fund units| | Rent | Pension Any other current income (Please specify) Declarations for remittances from NRO A/c: We cont tat 4. The amount emit out fhe bance hel my NRO secount/ ud the presen request snot exxeng USD 1 milion curing the cet fran Yen 2. The set ves aque bye / win accordance withthe foreign exchange nw in force atthe tine of accusion Fhe provisions of Foren Exchange Management (Acquiton and Tne of movable Property na Relations, 000.0. / We confi ha the amour does ntnvle the aout vested on aon reaaton ‘tsa apt appreciation thereon 5. Source of nds forthe present retnces ot om the kof arctan aration propery amheus propery in na 4:17 econ tat nrespact oases acqured unde a eed of etement made by eter of my ou paren or relate sete n Compas ct. 2013. The ‘ettement ha ten fect onthe dato he ett. 5. nase of eld property purchased a 2 Nen Resident inca the repateten of sal proceeds ra not exceelng 2 uch proper ‘ince th vemitance ing made ar than on tment ten the emdtance of al tales wl be made hough Ave Bak ton 7. Te saa emitarce sot tobe mide tof the rt’ blances eld the account ang i /hareinat reehabls andi rd not by borrowing om anv oe person ora trnatr fom ay eer RID acount af auch sod fob the case he account ker wil eer biel he ble for penal ce 18.17 contr tat |/ We ive pl the applicable tae in na onthe income deiared in applkation om 9.17 econ tat the amount tobe epatiatd doesnot exceed the amount od for acqusn cf theinmvable property ecelved trough normal banking channels or ‘ou offing eld in FONE) acount or NRE account ‘Slratureof te natal puaran of the Applian stepatureo th Appeant “where the splints minor the appeaton shoul be counters by minor’ natural aarn Date:erteae by the tore Delar “he et cetty thatthe renitance lent bang made by tonal ene an tht the emittance in confor wih the herons esd bythe Reserve Ban rom time to time uncer the Shere. For NTB Customer O5V 0 KY dcss done by Branch / Operation Head AML due lence done for high Cash Vale Tansctons! Name nd designation ofthe Authorised Oat Poe: sone. Sealand sigmture te eat tht have verted the Customers signature as per Bank records and etna the ergs fal the seared documents a fom suited by the ete forthe