15
Annex
FORM A2
(To be completed by the applicant)
(For payments other
than imports and
remittances covering
intermediary trade)
Application for
AD Code No.__________________________
Form No._____________________________
(To be filled in by the Authorised Dealer)
Currency_____ Amount ___Equivalent to Rs. ____
(To be completed by the Authorised Dealer)
I/We _____________________________________________________________
(Name of applicant remitter)
PAN No.
16
__________________________________________________________
Address___________________________________________________________
authorize
__________________________________________________________________
(Name of AD branch)
To debit my Savings Bank/ Current/ RFC/ EEFC A/c. No. ____________________
together with their charges and
* a) Issue a draft : Beneficiary's Name _________________________________
Address _________________________________
* b) Effect the foreign exchange remittance directly –
1) Beneficiary's Name __________________________________
2) Name and address of the bank __________________________________
3) Account No. __________________________________
* c) Issue travelers cheques for __________________________________
* d) Issue foreign currency notes for __________________________________
Amount (specify currency) __________________________________
* (Strike out whichever is not applicable) for the purpose/s indicated below
Whether under LRS
(Yes/No)
(Remitter should put a tick (√ ) against an appropriate purpose code. In case of doubt/
difficulty, the AD bank should be consulted).
15
Inserted vide AP (Dir) series Circular 50 dated February 11, 2016. Prior to insertion it read as Annex 1, which has since
been replaced with effect from the same date.
16
Modified vide AP (DIR) Series Circular No. 32 dated June 19, 2018. Prior to modification, it read “PAN No. (For
remittances exceeding USD 25,000 and for all capital account transactions)”