ADVANCE REMITTANCE AGAINST IMPORTS FORM

(To be completed by the applicant in block letters using black ink pen) Branch Name: AMBATTUR

Date: 21.05.2020
We will import following commodity/goods and request you to remit funds as per details given below:

Commodity: MOULD AND DIES HS Code: 84807900

Purpose of Remittance : AGAINST PURCHASE OF MOULD

Amount and Currency of 2600 USD 2 1 0 5 2 0 2 0
Value Date :
Remittance : D D M M Y Y Y Y

Foreign Bank Charges : Sharing Own Account Type of Good: Capital Non-Capital

Applicant(Company/Firm Name and Address) Beneficiary(Company/Firm Name and Address)

DR FOILS SHANGHAI SILVER ENGINEER INDUSTRY CO., LTD
NO 155A, 8 TH CROSS STREET No.66 Xinlv Rd., Xinbang, Songjiang, Shanghai, China
TASS INDUSTRIAL ESTATE
CHENNAI 600 098

Mobile : 96000 95500 Mobile : +86-15216689661

Contact Person : DEEPAK G Contact Person : FRANKY

Email : [email protected] Email : [email protected]

Beneficiary Bank (Name and Address) Miscellaneous Details of Transaction
PING AN BANK CO., LTD. (FORMERLY SHENZHEN DEVELOPMENT BANK Port of Loading : SHANGHAI
CO.,LTD.) SHENZHEN DEVELOPMENT BANK
BUILDING 5047 SHEN NAN ROAD EAST Port of Discharge : CHENNAI
SHENZHEN 518001 CHINA
Country of Origin :

Beneficiary Bank OSA11013056693901 If Part payment is made under the same invoice,
Account or IBAN Number: Please provide the below mentioned details:

BSB No/SORT CODE/ABA/ROUTING No : Bank Reference No. :

Currency and Amount :
Beneficiary Bank SWIFT Code : SZDBCNBS
Date of Remittance :
Correspondent/Intermediary Bank (Name and Address) :

Correspondent/Intermediary Bank SWIFT Code:

Authority to debit bank account :
Account Type Account Number Currency Amount

EEFC/RFC/DDA

CA/CC/OD 0 5 3 3 0 5 0 0 0 0 0 1 0 1 INR

Authority to debit charges (if different from above account) :

CA/CC/OD 0 5 3 3 0 5 0 0 0 0 0 1 0 1 INR
Forward Contract Details, If booked :
Forward Contract Number : Date :
Forward Contract Amount :
Due Date of Contract:
Amount to be utilized for remittance:
I hereby declare that all the information mentioned above is correct.
Authorised Signatory with
2 1 0 5 2 0 2 0
Date : Company/Firm Seal :
D D M M Y Y Y Y

Page 1/2
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TEAR IT FROM HERE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

-: ACKNOWLEDGMENT (To be retained by the customer):-

Received an application for _________________________________ (request type) for the amount of __________________________ from
M/s _________________________________________ on ______________ at________ AM/PM for its onward submission to TFBO, Gift City
for further processing vide Acknowledgement Number/Reference ID:__________________________.

Date:________________ Seal & Sign of Branch Official

 ADVANCE REMITTANCE AGAINST IMPORTS FORM
GENERAL DECLARATION

1. I/We confirm that the goods being imported by me/us are not covered under Negative list of imports as mentioned in Chapter of latest Exim
Policy in vogue and amendments there to till date and I/We are eligible to import the above mentioned goods under the current Export and Import Policy in
place. I/We confirm that said goods imported/being imported by me/us are not restricted for import through specific licensing under the above mentioned
policy and amendments. (This clause is not applicable in case the goods are under the negative list of import). .
2. I/We declare that we will submit within 90 days from the date of remittance the custom stamped Exchange Control copy of Bill of Entry/Post parcel
wrapper(for imports by post)/Courier Bill of Entry(for imports through courier)/ CA certificate (in case of Service Export) to Bank of Baroda .
.
3. I/We declare that in the event of non import of goods for which the remittance is requested I/we will take up the matter vigorously with the beneficiary for
refund of the remitted funds to India.
4. I/We further declare that we have not made payment against the same invoice/contract through any other AD Bank. .
5. I/we agree that in the event of transaction could not be executed/debited to my/ our account after submitting the request for processing to the bank
on account of insufficient/ unclear balance at the same time of execution of the transaction in my/ our account any exchange losses incurred in
.
this connection due to reversal of the Forex deal can be charged to my/our Bank of Baroda account.
6. I/we agree that in the event the transaction is cancelled or revoked by me/us after submitting the request for processing to the bank any exchange
losses incurred in this connection can be charged to my/our Bank of Baroda account. I/we further agree that once the funds remitted by me/us
...
have been transmitted by Bank of Baroda to the correspondent and/or beneficiary banks, Bank of Baroda shall not be responsible for any delays in
the disbursement of such funds including the withholding of such funds by the correspondent and/or beneficiary banks. I/We further agree that
once the funds remitted by me / us have been transmitted by Bank of Baroda, intermediary Bank charges may be levied by Correspondent and /
or BeneficiaryBanks, which may vary from bank to bank.
7. I/we agree that in the event the transaction being rejected by the beneficiary bank because of incorrect information submitted by me, any charges
levied by the beneficiary bank or exchange losses incurred in this connection can be charged to my Bank of Baroda account.
8. I/we also agree that the exchange rate will be applicable at the time of deal booking and may vary from the rate prevailing when the request is
submitted. I/we also understand that the rate communicated to us (if any) is an indicative rate and the actual rate may be different from the same.
9. I/we also declare that the transaction does not have linkage with Specially Designated Nations and blocked person (SDN) countries listed under OFAC/UN
sanctions in any manner .I/we undertake not to hold Bank of Baroda responsible for any of its action or inaction in respect of the OFAC-linked/UN
sanctioned transactions.
10. In case of merchanting trade transaction I/We undertake to complete the entire export and import leg within a maximum period of 270 days and also
undertake that outlay of funds will not exceed 4 months and without incurring any financial loss. We also undertake that both the legs of the merchanting
trade transaction will be routed through Bank of Baroda only.

FEMA DECLARATION

(Under Section10 (5), Chapter III of The Foreign Exchange Management Act, 1999)

I / We hereby declare that the transaction the details of which are specifically mentioned in this request letter does not involve, and is not designed for the
purpose of any contravention or evasion of the provisions of the aforesaid act of any rule, regulation, notification, direction or order made there under.
I/ We also hereby agree and undertake to give such information/ documents as will reasonably satisfy you about this transaction in terms of the above
declaration.
I/ We also undertake that if I/ We refuse to comply with any such requirements or make only unsatisfactory compliance therewith, the bank shall refuse in
writing to undertake the transaction and shall if it has reason to believe that any contravention /evasion is contemplated by me /us report the matter to Reserve
Bank Of India.
I / We further declare that the undersigned has/have the authority to give the above request, authority, declaration and undertaking on behalf of the
firm/company

Date : 2 1 0 5 2 0 2 0 Authorised Signatory with

D D M M Y Y Y Y Company/Firm Seal :
Documents enclosed (tick all that are relevant) Documents received
(For branch use only)
✔ *Proforma Invoice /contract signed and stamped by buyer and seller.
. .

Unconditional, irrevocable SBLC/ Guarantee from an International Bank of repute acceptable to Bank and situated outside
India or a guarantee of an AD Category -1 Bank in India, if such a guarantee is issued against the counter-guarantee of an ……………
International Bank of repute situated outside India in following cases:
If the request is for more than USD 200,000/- or equivalent for import of goods. .
If the request is for more than USD 500,000/- or equivalent for import of services.
.

Original valid license for import of negative list goods. .

Copy of IEC certificate issued by DGFT of the importer .
For import of rough diamonds, SSI certificate of importer .
For import of aviation-related purchases, document proof of permission from DGCA to operate Scheduled or Non-Scheduled ……………
Air Transport Service
Other documents if any (please specify) ..

* Mandatory Documents

Page 2/2