15Annex
FORM A2
(To be completed by the applicant)
AD Code No.___NA___
(For payments other Form No._____________________________
than imports and
remittances covering (To be filled in by the Authorised Dealer)
intermediary trade)
Application for Currency GBP Amount 1020.0 Equivalent to Rs.115010.0
Remittance Abroad (To be filled in by the Authorised Dealer)
I/We __________MANIJA___________________
(Name of applicant remitter)
PAN No. _____FSHPM3517G ________________
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Address ___ D/O: Sulemaan, Kuhli Kalan, Ludhiana, Punjab-141119 Kunis Kalan Punjab - 141119 ____
authorize
______Transcorp International Limited___________________
(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 ____Flywire Payments Corporation _______
2) Name of the bank ____CITIBANK NA
3) Address of the bank ____Citibank NA Citigroup Centre Canada Square Canary Wharf London E14
5LB United Kingdom
4) Account No. ____13264548
* 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
Sr. Whether under LRS Purpose Code Description
No. (Yes/No)
YES YES S0305 Overseas Education - University Fees
As per the Annex
(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)
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Declaration
(Under FEMA 1999)
1. # I, ___MANIJA ___(Name), hereby declare that the total amount of foreign exchange purchased from or
remitted through, all sources in India during the financial year including this application is within the overall limit of
the Liberalised Remittance Scheme prescribed by the Reserve Bank of India and certify that the source of funds
for making the said remittance belongs to me and the foreign exchange will not be used for prohibited purposes.
Details of the remittances made/transactions effected under the Liberalised Remittance Scheme in the current
financial year (April- March) .......
Sr. No. Date of Remittance FCN & Amount Equivalent to Rs. Equivalent to USD Name and address of AD
(Including Taxes) branch/FFMC through which the
transaction has been affected
-
Total Txn. Date Amount Name and address of AD branch/FFMC through which
0 23/12/2024 0.0 the transaction has been effected : Transcorp International Limited
RBI license No : AD 05/2015
2. # The total amount of foreign exchange purchased from or remitted through, all sources in India during this
calendar year including this application is within USD
250000 ____ (USD _______ ) the annual limit prescribed by Reserve Bank of India for the said purpose.
3. # Foreign exchange purchased from you is for the purpose indicated above. # (Strike out whichever is not
applicable )
Signature of the applicant
MANIJA
Date: Dec 23, 2024, 11:36:49 AM
Certificate by the Authorised Dealer
This is to certify that the remittance is not being made by/ to ineligible entities and that the remittance is in
conformity with the instructions issued by the Reserve Bank from time to time under the Scheme.
Name and designation of the authorised official:
Stamp and seal Signature:
Date:
Place:
This is a digitally generated A2 Form and Hence, does not contain the manual signature of the remitter
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