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App 05

The document provides sample forms for monthly foreign exchange transaction reporting by limited money changers, limited AD/booths, and diplomatic bonded warehouses. It includes sections for recording details of foreign exchange received and encashed with authorized dealers. The forms require information like dates, names, passport numbers, currencies, and amounts dealt with.

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KaziTanvirAhmed
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0% found this document useful (0 votes)
231 views

App 05

The document provides sample forms for monthly foreign exchange transaction reporting by limited money changers, limited AD/booths, and diplomatic bonded warehouses. It includes sections for recording details of foreign exchange received and encashed with authorized dealers. The forms require information like dates, names, passport numbers, currencies, and amounts dealt with.

Uploaded by

KaziTanvirAhmed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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APPENDIX 5

Specimen Forms of Applications,


Declaration etc. other than
Periodic Returns & Schedules
See Chapter 2 Para 2 APP. 5 1

MONTHLY STATEMENT OF FOREIGN EXCHANGE TRANSACTIONS BY LIMITED MONEY CHANGER


FOR THE MONTH OF ........................, 20…..............
Name of the Limited Money Changer: ...............................................................................................................................................................
Address: ..............................................................................................................................................................................................................
Name of the Currency:........................................................................................................................................................................................
Part -1 : Particulars of receiving foreign exchange from foreign nationals
Particulars of
Particulars of foreign nationals Particulars of foreign exchange received encashment
Date of
Sl No. certificate provided
receipt
Volume in Volume in Exchange
Name Country Passport No. No. Date
FC Eqv. BDT Rate

Part 2: Particulars of encashment of foreign exchange with AD


Particulars of encashment
Date of Name and address of Particulars of encashment
Sl No. certificate issued by AD
encashment AD
Volume in FC Volume in Eqv. BDT Ex. Rate No. Date

Part 3: Particulars of closing stock of foreign exchange at the end of .....................(month) 20….
Balance at the Closing balance at
Amount Received Encashment amount Other adjustment
Sl No. beginning of the the end of the Remarks
during the month with AD Bank (if any)
month month

Signature of the official of Limited Money Changer : Signature of the official of AD :

Name : .......................................................................... Name : ..........................................................................


Designation: ................................................................. Designation: .................................................................
Phone No.: ................................................................... Phone No.: ..................................................................
Note : Separate statement shall have to be submitted for each currency.
See Chapter 2 Para 2 APP. 5 2

MONTHLY STATEMENT OF FOREIGN EXCHANGE TRANSACTIONS OF LIMITED AD/BOOTH

Name of the Limited AD/Booth and Address: ...................................................................................................................................................


Name of the AD: ......................................................................Reporting Month: .........................................Year: ..........................................
Currency Name: ..................................................................................................................................................................................................
Part A: Particulars of receiving against buy or deposit to accounts*
Date of Purpose (Buy Encashment
Sl No. Name of the client Passport no. Country Amount or deposit to A/C)
receipt certificate No.

Part B : Particulars of sale or reconversion of FC


Date of sale/ Purpose
Sl No. Name of the client Passport no. Country Amount (sale or reconversion)
reconversion

Part C: Particulars of stock of FC


Opening FC Received during Sale to Transferred to Head
Total Reconversion Closing Remarks
stock the month customer office/AD
1 2 3 (1+2) 4 5 6 7=(3-4-5-6)

Signature : Signature :

Name of the authorised Name of the authorised


official of the AD: ........................................................................ official of the limited AD/Booth : ...................................................
Designation: ................................................................................. Designation : ...................................................................................
Phone No. ..................................................................................... Phone No: ........................................................................................

* Receipts will also include receiving FC for crediting FC A/C and NRTAs as mentioned in Para 1(D), Chapter 6.
Note : Separate set of statement shall have to be submitted for each currency.
See Chapter 2 Para 2 APP. 5 3

MONTHLY STATEMENT OF FOREIGN EXCHANGE INFLOWS AND OUTFLOWS OF DIPLOMATIC BONDED


WAREHOUSES FOR THE MONTH OF ..............., 20….
Name of the Diplomatic Bonded Warehouse: ....................................................................................................................................................
Address: ..............................................................................................................................................................................................................
Name of the AD (s) maintaining FC Account(s) with name of currency: .........................................................................................................
Opening Balance of Foreign Exchange Inflows of Foreign Exchange During the Month Deposited to Bank
Other (including Other (A/c
Cash FC Cheque/draft Cheque/
At bank cheque, draft at Total Cash transfer, credit Cash
in hand etc. draft etc.
hand, if any)* card settlement)
1 2 3 4 5 6 7 8 9

Outflows of Foreign Exchange During the Month Closing Balance of Foreign Exchange Gross
Payment Other profit
Amount of FC
against import Other Other (including during
converted to At bank Cash FC Total
during the adjustments in adjustments cheque, draft the
Taka from FC in hand
month from FC account* in cash* at hand, if month **
account
FC Account any)*
14(1+7+8+9 15(2+5-8-
10 11 12 13 16 (3+6-9) 17(14+15+16)
-10-11-12) 13)

* Please specify, ** Sale price of merchandise minus purchase price of merchandise during the month.
It is certified that the information given above correctly reflects the transaction of foreign exchange with regard to sales and purchases of the bonded
warehouse. We undertake that we will render ourselves liable for action under the Foreign Exchange Regulation Act, 1947 (amended up to September
09, 2015) if any information furnished above is found incorrect.
Name of the authorised person: ..............................................................................................................................................................................................
Signature: .....................................Contact no : Phone:......................................Mobile : .................................... E-mail : .................................................
Note : All amounts to be shown in USD. For conversion of other foreign currencies, the exchange rate of the last day of the month shall be used
except for the opening balance for which the rate of the last day of the previous month shall be used. If the bonded warehouse has more than one FC
accounts, only one consolidated statement will have to be prepared and submitted.
See Chapter 2 Para 5 APP. 5 4

Serial No............................ Date : .............................

ENCASHMENT CERTIFICATE

(Commercial name of the Money Changer)

(Operating under the Money Changer's Licence No...................................... dt. .............................

issued by Bangladesh Bank)

Certified that we have encashed today the following amounts of foreign currency notes and
coins from Mr./Ms. ................................................................................................................
..................................... an/a ....................................................... national, whose passport no. is
....................................................... and whose date of last arrival in Bangladesh as recorded by

immigration authorities in his passport is ....................................................................................... :

Name of currency Rate of exchange Amount paid in


Amount
applied in conversion Taka
to Taka

Authorised Signature and Seal

Note : ADs/Booths shall issue encashment certificate to their clients against buying of foreign
exchange (Para 14, Chapter 5) using the above mentioned format in their own letter
head pad.
See Chapter 2 Para 10 APP. 5 5

MONTHLY RETURNS OF MONEY CHANGER

Name of the Money Changer ..................................................................................................................................................................................................


Statement of particulars of sales and purchases of foreign exchange for the month of .........................................................................................................
Name of foreign currency ...............................................................................................( separate statement is to be submitted for each foreign currency)

Exchange

Particulars of the Seller Receipt /Encashment


Date of
e
No

Part 2 : Sale of Foreign Exchange to Customers

Date of Particulars of Sales ( Amount)


Sl No.
Sale
Total

Part 3 : Sale of Foreign Exchange to ADs


Name of the AD Bank and Branch Amount Sold
Sl No Date
(Buyer) Cash From FC Account
Page-2
See Chapter 2 Para 10 APP. 5 5

Part -4: Particulars of Transactions with Authorised Dealer Bank Through FC Account

In the Foreign Currency Account of ................................................................................................................................ ( Name of the Money Changer)

Deposit of Deposit of Received from Issue of Cash Payment to Transfer to Encashment


Foreign to Cash with
Cash TC Foreign Currency Foreign Blank TC
Currency any AD
Account of other Currency Supplier Account of
Money Changers other Money
Changers

Part -5: Statement of Stock of Cash Foreign Exchange and Blank TC

Blank TC Blank TC

Certification of Authorised Dealer Bank: ..............................................................................................................................................................................


This is to certify that the information furnished on Part -4 are in order with records/books of accounts maintained in this branch.

Signature of Authorised Person of the Authorised Dealer Signature of Authorised Person of the Money Changer
Date : ...................................Seal : Date : ..............................Seal :
See Chapter 4 Para 1 APP. 5 6

HALF YEARLY REPORT ON CORRESPONDENT BANKING :


REPORTING PERIOD : END OF JUNE /DEC, 20..........................
Name of The Bank: ......................................................................................................................................................................................................................................

Part A : Particulars of Nostro Accounts as on End of Period

Amount Transacted During


Sl No SWIFT ID Name of the Correspondents City/Branch Country Currency the Period (As per corrs. End Balance
book)
Dr Cr

Part B : Particulars of Nostro Accounts Opened During the Half Year Under Report

Amount Transacted During


Sl No SWIFT ID Name of the Correspondents City/Branch Country Currency the Period (As per corrs. End Balance
book)
Dr Cr

Part C : Particulars of Nostro Accounts Closed During the Half Year Under Report

Reason for Amount Transacted End


Sl No SWIFT ID Name of the Correspondents City/Branch Country Currency Closure During the Period (As per Balance
corrs. book) (If any)
Dr Cr

Part D : Particulars of Vostro Accounts as on End of Period


Amount Transacted During
Sl No SWIFT ID Name of the Correspondents City/Branch Country Currency the Period (As per own End Balance
book)
Dr. Cr.
Contd.......... page 2
Page-2
See Chapter 4 Para 1 APP. 5 6

Part E : Particulars of Vostro Accounts Opened During the Half Year Under Report

Amount Transacted During


Sl No SWIFT ID Name of the Correspondents City/Branch Country Currency the Period (As per own End Balance
book)
Dr. Cr.

Part F : Particulars of Vostro Accounts Closed During the Half Year Under Report

Reason for Amount Transacted End


Sl No SWIFT ID Name of the Correspondents City/Branch Country Currency Closure During the Period (As per Balance
own book) (If any)
Dr. Cr.

Part G : Particulars of Bank A/Cs of Own Exchange Houses Abraod as on End of Period

Amount Transacted During


Name of the Ex
Sl No Account Maintaining bank City/Branch Country Currency the Period (As per End Balance
House/City/Country
bank's book)
Dr Cr

Part H : Particulars of Bank A/C of Own Exchange Houses Abraod Opened During the Half Year Under Report

Name of the Ex Amount Transacted During the End


Sl No Account Maintaining bank City/Branch Country Currency
House/City/Country Period (As per bank's book) Balance
Dr Cr
Contd.......... page 3
Page-3
See Chapter 4 Para 1 APP. 5 6

Part I : Particulars of Bank A/C of Own Exchange Houses Abraod Closed During the Half Year Under Report

Reason for End


Name of the Ex Account maintaining Amount Transacted During the
Sl No City/Branch Country Currency closure Balance(If
House/City/Country bank Period (As per bank's book)
amy)
Dr Cr

Part J Particulars of Country-wise SWIFT Relationship Management Application (RMA) for the Half Year Under Report

No. of RMAs at the end No. of RMA opened No. of RMA closed
Sl No Name of the Country Reason for closure
of period during the period during the period

Part K : Comments regarding corresponding banking (any problem, observation or suggestion) : Please use separate page if needed.

Note : Information of vostro accounts will include those of banks abroad only . Vostro accounts or nonresident taka accounts of exchange
houses abroad (under drawing arrangement agreement) will not be included in Part D, E and F.
-
This is to certify that information provided above is correct.

Name of the authorised bank official : ..............................................


Designation: ......................................................................................... Note : Unless otherwise instructed by FEPD, Head offfice,
Bangladesh Bank, the statement shall be submitted through e-mail
Phone No : Land...............................................Cell............................... only in MS-Excel. Scanned/PDF copy will not be accepted.
See Chapter 4 Para 14 APP. 5 7

APPROPRIATENESS MEMO

Customer Name : ............................................................ (Internal Credit Rating .........................)

Transaction Details : ...............................................................................................................................

Date : ................................................................................................................................

Products : Commodity Derivatives

What is the customer's annual import volume (Quantity and in USD terms) of the commodity that
he/she wants to hedge? Please provide monthly import figures of the last one year.
Why is the customer doing these transactions? How do the transactions fit the customer's business?
What is the company's general view toward derivatives and how does the company use them?
Does the client have formal/informal derivatives policies? What are they?
Does the customer have the legal authority to enter into derivatives transactions? Is the company
allowed to use derivatives under the terms of its constituent documents? Is there any limitation on
specific types of derivatives, or caveats over capacity (e.g. "only if hedging")?
How has the client used derivatives in the past and in what new areas are they applying derivatives?
Are recent derivatives transactions consistent with the past; if not, why?
How sophisticated is the company? Do they have their own pricing models? Do they build their own
spreadsheets? Do they have access to market data (e.g. Reuters, Telerate, and Bloomberg)?
At what level are derivatives approved at the company? How active is senior management in decision
making and/or monitoring derivatives activity?
Is there evidence of "doubling up" or similar activity to erase earlier losses?
Is documentation complete? Are we comfortable as a credit matter with incomplete
documentation?

Dealing Officer/ Corporate Banking Officer/


Treasury Marketing Officer Relationship Manager

Head of Corporate Banking/


Relationship Head
See Chapter 4 Para 14 APP. 5 8

CUSTOMER'S SUITABILITY AND APPROPRIATENESS


[Periodic Review] (Preferably annual)

From: [Head of Corporate Banking/Relationship Head]

Date: .........................................................................

Re: Customer's Suitability and Appropriateness

I/we have determined the following with regard to the customer identified below:

1. Identity of Client - [ ]. This client has been designated as a [Market Participant (e.g
banks)/Non-Professional Counterparty (customers)].

2. Summary of Client's past trading history with [authorised dealer] and (to the extent known)
with other banks and financial institutions -

3. Summary of the type and tenor of transactions which we expect the Client to enter into with
[authorised dealer] in future and why the Client would enter into such transactions -

4. Description of the Client's personnel with trading authority and their trading experience -

5. Description of the Client's risk management and control processes, including senior
management involvement -

6. Any additional notes/remarks as are relevant or necessary -

Dealer Corporate Banking Officer/


Relationship Manager
See Chapter 5 Para 2 APP. 5 9

TM ID Inward Reference
AD Code Ref. Year FORM 'TM' AD Code Ref. Year
Travel and Miscellaneous
Purposes (other than import)

APPLICATION FOR PERMISSION UNDER FOREIGN EXCHANGE


REGULATION ACT, 1947 TO PURCHASE FOREIGN EXCHANGE
FOR THE PURPOSE SPECIFIED BELOW
To
.........................................................
........................................................
.........................................................
(Name & address of the Bank to which application is made)
I/We wish to purchase/remit ................................................................................................ for the under
(Amount in figures and words stating currency)
mentioned purpose:-
I/We hereby declare that the statements made by me/us on this form are true and that I/we have not
already obtained exchange nor have I/we made any other application for the purpose.
* A. For Travel Purposes:
I /We desire to travel to ............................................. for the purpose of ..................................................
The journey will be undertaken by ...................................................................................................
(Name of the Air/Shipping Company)
My/Our Passport Nos, date & place of issue are given below:-
(a)
(b)
(c)
*B. For miscellaneous purposes other than travel and import:
(a) Reason for payment .....................................................................................................................
(b) Name & address of beneficiary ...................................................................................................
(c) Country of beneficiary ...............................................................................................................

Signature, Name and Address


of the Applicant
Contd...P/2
Page-2
See Chapter 5 Para 2 APP. 5 9

Declaration to be signed by the traveller/remitter


(a) That I/we recognise that in the event of any misrepresentation or suppression of any material fact,
I/we shall be liable to action under the Foreign Exchange Regulation Act, 1947.
(b) That the foreign exchange released to me/us shall be used for expenses incurred by means in
foreign country/countries for
*(i) my/our living and travelling expenses for business purposes.
*(ii) my/our enroute expenses for travel abroad.
*(iii) my/our living expenses and medical treatment.
(c) I/We am/are aware that exchange issued to me/us under this form for travel purposes may only
be taken out by me/us on my/our departure from Bangladesh and may not be sent out by post or
through the medium of any other person or by any other means.
(d) That if the travel has not been undertaken for the purpose mentioned above, or if any unspent
foreign exchange remaining in my/our possession or at my/our disposal or which could not be
utilised for the purpose for which it was granted, will be sold by me/us to an Authorised Dealer in
foreign exchange in Bangladesh immediately on my/our return to Bangladesh.
*(e) I/We declare that the payment mentioned against 'b' above is due to be made by me/us for which
documentary evidence is enclosed and assume full responsibility for complying with the
provisions of the Foreign Exchange Regulation Act, 1947 and rules, orders and directives issued
thereunder.

Signature of the applicant

Certificate of approval of the Bangladesh Bank (if required).


[Valid for 30 (thirty) days from the date of approval]

Date of approval. Seal & Signature of the Bangladesh Bank Official

(Certificate by Authorised Dealer)


*(a) We have issued Notes & Coins ..............................T/C ........................... L/C ...............................
Total........................ as per Bangladesh Bank approval dated.................................................... and
endorsed the amount released in the traveller's passport after examining the ticket covering the passage.
*(b) We have effected remittance of ........................................................................................................
(State amount)
in terms of Para ..................Chapter....................of GFET/Bangladesh Bank's
approval No. .................... dated ....................by.......................on............................(TT/MT/Draft)
Contd...P/3
Page-3
See Chapter 5 Para 2 APP. 5 9

Cage to be completed by Authorised Dealer indicating Code No. as per Code list circulated by the
Bangladesh Bank.

Country of
Month Purpose Category Currency Amount in foreign currency
beneficiary

Signature and Stamp of the


Authorised Dealer

I/ we hereby certify having received the exchange issued to me/us as above.

Signature(s) of the Applicant(s)

* Strike out items not applicable


See Chapter 5 Para 10 APP. 5 10
FORM-C

DECLARATION FOR REMITTANCE RECEIVED FROM FOREIGN


COUNTRY OF AMOUNT EXCEEDING USD 10,000 OR EQUIVALENT

I/We do hereby declare that I/we have received remittance of

(Amount and Currency in figures and in words)

remitted or

to be remitted by on account of
(name and address of remitting bank)

for the purpose of


name and address of remitter) (purpose of remittance)

(Name of Applicant)

Nationality
Date ..................... Address

Signature and Stamp of the applicant

From-C : Inward Remittance exceeding USD 10,000 (Ten thousand) or equivalent.


Country of Ordering Amount in
Month Purpose
Customers (State Currency)

Coded by
Checked by

Purpose of remittance
We hereby certify that we are satisfied as to the identity of the applicant and that we have seen
documentary evidence which satisfies us as to the bonafides of the declaration made on this form.

Date ........................... Signature and Stamp of the


Authorised Dealer
Contd, P/2
See Chapter 5 Para 10 Page-2 APP. 5 10

(Space for use by the Bangladesh Bank)

BANGLADESH BANK
Foreign Exchange Policy Department

Date ............................ Assistant Director

Note: Full details must be given for all remittances which are of capital nature. In the case of amounts
for investment in Bangladesh in shares or business, the reasons why the investment is required must be
clearly indicated. In the case of the remittance of the sale proceeds of securities the name of the true
owner of the securities must be given and also the approximate date of purchase.

Inward ID Outward Reference


AD Code Ref. Year AD Code Ref. Year
See Chapter 5 Para 10 APP. 5 11

FORM-C(ICT)

DECLARATION FOR INWARD REMITTANCE ON ACCOUNT OF ICT


RELATED SERVICES OF AMOUNT EXCEEDING USD 10,000 OR EQUIVALENT

I/We do hereby declare that I/we have received remittance of …………….. (amount) which is a fair
value against ICT related services described below in respect of which this declaration is made out and
that the particulars given below are true:
a) Remitter’s name and address:
b) Remitting bank and address:
c) Reference No (contract/invoice/electronic communication etc.):
d) Purpose (please tick):
 Information Technology Enabled Services (IT Enabled Services) and Business Process
Outsourcing (BPO) services – code 2410
 Computer and Information Technology consultancy and management services– code 2411
 Export of computer software including turn-key basis (customized)– code 2412
 Export of computer software including turn-key basis (non-customized) – code 2413
 Installation services concerning hardware and software maintenance and repairs of computers and
peripheral equipment services – code 2414
 ………………………. (please specify
Note: Please see the “Code lists for Reporting of External Sector transactions by the Authorised dealers”
for explanatory notes of above purposes.
Signature with name of applicant : ..................................................................................................................
Address : ..........................................................................................................................................................
Date : ..............................................................................................................................................................

(for AD’s use only)


Month Country of ordering Amount in
customer Purpose (state currency)

Coded by : .............................................................

Checked by : .........................................................
Signature and stamp of Authorised Dealer:
Purpose of remittance : ......................................... Date:

Inward ID Outward Reference


AD Code Ref. Year AD Code Ref. Year
See Chapter 6 Para 1 (A) APP. 5 12

evsjv‡`k e¨vs‡Ki Kwc (Copy for Bangladesh Bank) cÖ_g Kwc (First Copy)
GdGg‡R dig
‰e‡`wkK gy`ªvi †NvlYv dig
(FOREIGN EXCHANGE DECLARATION FORM )
FMJ FORM

(1947 mv‡ji ˆe‡`wkK gy`ªv wbqš¿Y AvBb Gi 8(1) aviv Abyhvqx evsjv‡`k e¨vsK KZ…©K cÖewZ©Z)
(Prescribed by Bangladesh Bank Under Section 8(1) of the Foreign Exchange Regulation Act, 1947 )

GB digwU evsjv‡`‡k AvMgbKvix e¨w³ KZ…©K c~iY Kwi‡Z nB‡e|


This form is to be filled in by a person entering Bangladesh.

c~Y© bvg RvZxqZv


(Full Name): (Nationality)

cvm‡cvU© bs Bmy¨i ZvwiL Bmy¨i ¯’vb


(Passport No) (Date of Issue) (Place of Issue)
AvMg‡bi ZvwiL I mgq d¬vBU b¤^i
(Date & time of arrival) (Flight No.)
evsjv‡`‡k wVKvbv we‡`‡k Ae¯’v‡bi †gqv`
(Address in Bangladesh) (Duration of stay in abroad)
†ckv †hvMv‡hvM b¤^i
(Profession) (Contact No)

†NvlYv
DECLARATION

ms‡M AvbxZ bM` ‰e‡`wkK gy`ªv Ges n¯ÍvšÍi‡hvM¨ evn‡Ki `wjj (WªvdU, †c AW©vi, Uªv‡fjvim †PK BZ¨vw`)/Cash and
negotiable bearer instruments in foreign currency (drafts, pay orders, traveler's cheques etc) brought in:

‰e‡`wkK gy`ªvi eY©bv cwigvY K_vq


(Description of foreign Currency) (Amount) (In words)

Avwg wb¤œ¯^vÿiKvix, GZØviv cÖZ¨qb Kwi‡ZwQ †h, Dc‡i cÖ`Ë Z_¨mg~n mwVK|
(I, the undersigned, hereby solemnly declare that the information given above is correct.)

ïé Kg©KZ©vi ¯^vÿi t †NvlYvKvixi ¯^vÿi t


Signature of Customs Official : Signature of Declarant :
ZvwiL t ZvwiL t
See Chapter 6 Para 1 (A) Page-2 APP. 5 12

Information for Declarant


(‡NvlYvKvixi Rb¨ ÁvZe¨)

1. An incoming/outgoing passenger may bring in/take out upto Taka 10,000(Ten thousand) in
Bangladesh currency at the time of arrival into/departure from Bangladesh.

1| evsjv‡`‡k AvMgb/evsjv‡`k nB‡Z ewnM©gbKv‡j †Kvb e¨w³ evsjv‡`kx gy`ªv AbwaK 10,000(`k nvRvi) UvKv
Avwb‡Z/jBqv hvB‡Z cvwi‡eb|
2. Any amount of foreign currency may be brought in by an incoming passenger with declaration to
the customs authorities in Form FMJ. No declaration, however, is necessary for amounts brought
in upto US$ 5000(five thousand) or equivalent. For a foreigner, the entire amount brought in with
declaration or upto US$ 5000(five thousand) brought in without declaration may be taken out
freely at the time of departure. Upto US$ 5000(five thousand) brought in without declaration by a
Bangladeshi may also be retained and taken out freely while proceeding abroad. Amount in
excess of US$ 5000(five thousand) brought in by the resident Bangladeshis, should, however, be
encashed or deposited in appropriate foreign currency account within 30(thirty) days of arrival.
Such amounts brought in by non-resident Bangladeshis can be encashed or deposited in foreign
currency account any time after return to Bangladesh.

2| ïé KZ…©c‡ÿi wbKU GdGg‡R di‡g †NvlYv cÖ`vb Kwiqv †h †Kvb cwigvY ˆe‡`wkK gy`ªv evsjv‡`‡k AvMgbKv‡j
m‡½ Avbv hvB‡Z cv‡i| Z‡e AvbxZ ˆe‡`wkK gy`ªvi cwigvY AbwaK gvtWt 5000(cuvP nvRvi) ev mgZzj¨ nB‡j
ïé KZ…©c‡ÿi wbKU †NvlYv cÖ`vb Avek¨K nB‡e bv| we‡`kxM‡Yi †ÿ‡Î †NvlYv cÖ`vb Kwiqv AvbxZ mgy`q
ˆe‡`wkK gy`ªv Ges †NvlYv cÖ`vb e¨wZ‡i‡K AvbxZ AbwaK gvtWt 5000(cuvP nvRvi) evsjv‡`k Z¨vMKv‡j Aev‡a
cÖZ¨vevmb‡hvM¨ nB‡e| †NvlYv cÖ`vb e¨wZ‡i‡K AvbxZ AbwaK gvtWt 5000(cuvP nvRvi) evsjv‡`kx bvMwiKM‡Yi
†ÿ‡ÎI m‡½ iÿY‡hvM¨ Ges evsjv‡`k nB‡Z ewn©MgbKv‡j m‡½ enb‡hvM¨ nB‡e; GZ`&wZwi³ †h †Kvb AsK
wbevmx evsjv‡`kx‡`i †ÿ‡Î evsjv‡`‡k AvMg‡bi 30(wÎk) w`‡bi g‡a¨ UvKvq fv½vB‡Z/cÖ‡hvR¨ ai‡Yi ˆe‡`wkK
gy`ªv wnmv‡e Rgv Kwi‡Z nB‡e| Awbevmx evsjv‡`kx KZ…©K AvbxZ GBiƒc AsK evsjv‡`‡k †diZ Avwmevi ci †h
†Kvb mgq UvKvq fv½vB‡Z cvwi‡eb A_ev ˆe‡`wkK gy`ªv wnmv‡e Rgv Kwi‡Z cvwi‡eb|
3. Encashment of foreign exchange brought in should be done with licenced Money Changers/
Authorised Dealer bank branches.

3| m‡½ AvbxZ ˆe‡`wkK gy`ªv UvKvq bM`vqb jvB‡mÝ cÖvß gvwb‡PÄvi/Aby‡gvw`Z wWjvi e¨vsK kvLvi gva¨‡g m¤úv`b
Kwi‡Z nB‡e|
4. An incoming/outgoing adult female passenger may bring in/take out any quantity of personal
jewellery worn on her person or as part of her accompanying personal baggage.

4| evsjv‡`‡k AvMgb/evsjv‡`k nB‡Z ewnM©gbKv‡j †Kvb cÖvß eq¯‹v gwnjv hvÎx ¯^xq cwiav‡b A_ev e¨w³MZ
e¨v‡M‡Ri Askiƒ‡c †h †Kvb cwigvY e¨w³MZ AjsKvivw` m‡½ Avwb‡Z/jBqv hvB‡Z cvwi‡eb|
See Chapter 6 Para 1 (A) APP. 5 12

Kv÷gm& Gi Kwc (Copy for Customs) wØZxq Kwc (Second Copy)


GdGg‡R dig
‰e‡`wkK gy`ªvi †NvlYv dig
(FOREIGN EXCHANGE DECLARATION FORM )
FMJ FORM

(1947 mv‡ji ˆe‡`wkK gy`ªv wbqš¿Y AvBb Gi 8(1) aviv Abyhvqx evsjv‡`k e¨vsK KZ…©K cÖewZ©Z)
(Prescribed by Bangladesh Bank Under Section 8(1) of the Foreign Exchange Regulation Act, 1947 )

GB digwU evsjv‡`‡k AvMgbKvix e¨w³ KZ…©K c~iY Kwi‡Z nB‡e|


This form is to be filled in by a person entering Bangladesh.

c~Y© bvg RvZxqZv


(Full Name): (Nationality)

cvm‡cvU© bs Bmy¨i ZvwiL Bmy¨i ¯’vb


(Passport No) (Date of Issue) (Place of Issue)
AvMg‡bi ZvwiL I mgq d¬vBU b¤^i
(Date & time of arrival) (Flight No.)
evsjv‡`‡k wVKvbv we‡`‡k Ae¯’v‡bi †gqv`
(Address in Bangladesh) (Duration of stay in abroad)
†ckv †hvMv‡hvM b¤^i
(Profession) (Contact No)
†NvlYv
DECLARATION

ms‡M AvbxZ bM` ‰e‡`wkK gy`ªv Ges n¯ÍvšÍi‡hvM¨ evn‡Ki `wjj (WªvdU, †c AW©vi, Uªv‡fjvim †PK BZ¨vw`)/Cash and
negotiable bearer instruments in foreign currency (drafts, pay orders, traveler's cheques etc) brought in:

‰e‡`wkK gy`ªvi eY©bv cwigvY K_vq


(Description of foreign Currency) ( Amount) (In words)

Avwg wb¤œ¯^vÿiKvix, GZØviv cÖZ¨qb Kwi‡ZwQ †h, Dc‡i cÖ`Ë Z_¨mg~n mwVK|
(I, the undersigned, hereby solemnly declare that the information given above is correct.)

ïé Kg©KZ©vi ¯^vÿi t †NvlYvKvixi ¯^vÿi t


Signature of Customs Official : Signature of Declarant :
ZvwiL t ZvwiL t
See Chapter 6 Para 1 (A) Page-2 APP. 5 12

Information for Declarant


(‡NvlYvKvixi Rb¨ ÁvZe¨)

1. An incoming/outgoing passenger may bring in/take out upto Taka 10,000(Ten thousand) in
Bangladesh currency at the time of arrival into/departure from Bangladesh.

1| evsjv‡`‡k AvMgb/evsjv‡`k nB‡Z ewnM©gbKv‡j †Kvb e¨w³ evsjv‡`kx gy`ªv AbwaK 10,000(`k nvRvi) UvKv
Avwb‡Z/jBqv hvB‡Z cvwi‡eb|
2. Any amount of foreign currency may be brought in by an incoming passenger with declaration to
the customs authorities in Form FMJ. No declaration, however, is necessary for amounts brought
in upto US$ 5000(five thousand) or equivalent. For a foreigner, the entire amount brought in with
declaration or upto US$ 5000(five thousand) brought in without declaration may be taken out
freely at the time of departure. Upto US$ 5000(five thousand) brought in without declaration by a
Bangladeshi may also be retained and taken out freely while proceeding abroad. Amount in
excess of US$ 5000(five thousand) brought in by the resident Bangladeshis, should, however, be
encashed or deposited in appropriate foreign currency account within 30(thirty) days of arrival.
Such amounts brought in by non-resident Bangladeshis can be encashed or deposited in foreign
currency account any time after return to Bangladesh.

2| ïé KZ…©c‡ÿi wbKU GdGg‡R di‡g †NvlYv cÖ`vb Kwiqv †h †Kvb cwigvY ˆe‡`wkK gy`ªv evsjv‡`‡k AvMgbKv‡j
m‡½ Avbv hvB‡Z cv‡i| Z‡e AvbxZ ˆe‡`wkK gy`ªvi cwigvY AbwaK gvtWt 5000(cuvP nvRvi) ev mgZzj¨ nB‡j
ïé KZ…©c‡ÿi wbKU †NvlYv cÖ`vb Avek¨K nB‡e bv| we‡`kxM‡Yi †ÿ‡Î †NvlYv cÖ`vb Kwiqv AvbxZ mgy`q
ˆe‡`wkK gy`ªv Ges †NvlYv cÖ`vb e¨wZ‡i‡K AvbxZ AbwaK gvtWt 5000(cuvP nvRvi) evsjv‡`k Z¨vMKv‡j Aev‡a
cÖZ¨vevmb‡hvM¨ nB‡e| †NvlYv cÖ`vb e¨wZ‡i‡K AvbxZ AbwaK gvtWt 5000(cuvP nvRvi) evsjv‡`kx bvMwiKM‡Yi
†ÿ‡ÎI m‡½ iÿY‡hvM¨ Ges evsjv‡`k nB‡Z ewn©MgbKv‡j m‡½ enb‡hvM¨ nB‡e; GZ`&wZwi³ †h †Kvb AsK
wbevmx evsjv‡`kx‡`i †ÿ‡Î evsjv‡`‡k AvMg‡bi 30(wÎk) w`‡bi g‡a¨ UvKvq fv½vB‡Z/cÖ‡hvR¨ ai‡Yi ˆe‡`wkK
gy`ªv wnmv‡e Rgv Kwi‡Z nB‡e| Awbevmx evsjv‡`kx KZ…©K AvbxZ GBiƒc AsK evsjv‡`‡k †diZ Avwmevi ci †h
†Kvb mgq UvKvq fv½vB‡Z cvwi‡eb A_ev ˆe‡`wkK gy`ªv wnmv‡e Rgv Kwi‡Z cvwi‡eb|
3. Encashment of foreign exchange brought in should be done with licenced Money Changers/
Authorised Dealer bank branches.

3| m‡½ AvbxZ ˆe‡`wkK gy`ªv UvKvq bM`vqb jvB‡mÝ cÖvß gvwb‡PÄvi/Aby‡gvw`Z wWjvi e¨vsK kvLvi gva¨‡g m¤úv`b
Kwi‡Z nB‡e|
4. An incoming/outgoing adult female passenger may bring in/take out any quantity of personal
jewellery worn on her person or as part of her accompanying personal baggage.

4| evsjv‡`‡k AvMgb/evsjv‡`k nB‡Z ewnM©gbKv‡j †Kvb cÖvß eq¯‹v gwnjv hvÎx ¯^xq cwiav‡b A_ev e¨w³MZ
e¨v‡M‡Ri Askiƒ‡c †h †Kvb cwigvY e¨w³MZ AjsKvivw` m‡½ Avwb‡Z/jBqv hvB‡Z cvwi‡eb|
See Chapter 6 Para 1 (A) APP. 5 12

hvÎxi Kwc (Copy for Passenger) Z…Zxq Kwc (Third Copy)


GdGg‡R dig
‰e‡`wkK gy`ªvi †NvlYv dig
(FOREIGN EXCHANGE DECLARATION FORM )
FMJ FORM

(1947 mv‡ji ˆe‡`wkK gy`ªv wbqš¿Y AvBb Gi 8(1) aviv Abyhvqx evsjv‡`k e¨vsK KZ…©K cÖewZ©Z)
(Prescribed by Bangladesh Bank Under Section 8(1) of the Foreign Exchange Regulation Act, 1947 )

GB digwU evsjv‡`‡k AvMgbKvix e¨w³ KZ…©K c~iY Kwi‡Z nB‡e|


This form is to be filled in by a person entering Bangladesh.

c~Y© bvg RvZxqZv


(Full Name): (Nationality)

cvm‡cvU© bs Bmy¨i ZvwiL Bmy¨i ¯’vb


(Passport No) (Date of Issue) (Place of Issue)
AvMg‡bi ZvwiL I mgq d¬vBU b¤^i
(Date & time of arrival) (Flight No.)
evsjv‡`‡k wVKvbv we‡`‡k Ae¯’v‡bi †gqv`
(Address in Bangladesh) (Duration of stay in abroad)
†ckv †hvMv‡hvM b¤^i
(Profession) (Contact No)
†NvlYv
DECLARATION
ms‡M AvbxZ bM` ‰e‡`wkK gy`ªv Ges n¯ÍvšÍi‡hvM¨ evn‡Ki `wjj (WªvdU, †c AW©vi, Uªv‡fjvim †PK BZ¨vw`)/Cash and
negotiable bearer instruments in foreign currency (drafts, pay orders, traveler's cheques etc) brought in:

‰e‡`wkK gy`ªvi eY©bv cwigvY K_vq


(Description of foreign Currency) ( Amount) (In words)

Avwg wb¤œ¯^vÿiKvix, GZØviv cÖZ¨qb Kwi‡ZwQ †h, Dc‡i cÖ`Ë Z_¨mg~n mwVK|
(I, the undersigned, hereby solemnly declare that the information given above is correct.)

ïé Kg©KZ©vi ¯^vÿi t †NvlYvKvixi ¯^vÿi t


Signature of Customs Official : Signature of Declarant :
ZvwiL t ZvwiL t
Page-2
See Chapter 6 Para 1 (A) APP. 5 12

Information for Declarant


(‡NvlYvKvixi Rb¨ ÁvZe¨)

1. An incoming/outgoing passenger may bring in/take out upto Taka 10,000(Ten thousand) in
Bangladesh currency at the time of arrival into/departure from Bangladesh.

1| evsjv‡`‡k AvMgb/evsjv‡`k nB‡Z ewnM©gbKv‡j †Kvb e¨w³ evsjv‡`kx gy`ªv AbwaK 10,000(`k nvRvi) UvKv
Avwb‡Z/jBqv hvB‡Z cvwi‡eb|
2. Any amount of foreign currency may be brought in by an incoming passenger with declaration to
the customs authorities in Form FMJ. No declaration, however, is necessary for amounts brought
in upto US$ 5000(five thousand) or equivalent. For a foreigner, the entire amount brought in with
declaration or upto US$ 5000(five thousand) brought in without declaration may be taken out
freely at the time of departure. Upto US$ 5000(five thousand) brought in without declaration by a
Bangladeshi may also be retained and taken out freely while proceeding abroad. Amount in
excess of US$ 5000(five thousand) brought in by the resident Bangladeshis, should, however, be
encashed or deposited in appropriate foreign currency account within 30(thirty) days of arrival.
Such amounts brought in by non-resident Bangladeshis can be encashed or deposited in foreign
currency account any time after return to Bangladesh.

2| ïé KZ…©c‡ÿi wbKU GdGg‡R di‡g †NvlYv cÖ`vb Kwiqv †h †Kvb cwigvY ˆe‡`wkK gy`ªv evsjv‡`‡k AvMgbKv‡j
m‡½ Avbv hvB‡Z cv‡i| Z‡e AvbxZ ˆe‡`wkK gy`ªvi cwigvY AbwaK gvtWt 5000(cuvP nvRvi) ev mgZzj¨ nB‡j
ïé KZ…©c‡ÿi wbKU †NvlYv cÖ`vb Avek¨K nB‡e bv| we‡`kxM‡Yi †ÿ‡Î †NvlYv cÖ`vb Kwiqv AvbxZ mgy`q
ˆe‡`wkK gy`ªv Ges †NvlYv cÖ`vb e¨wZ‡i‡K AvbxZ AbwaK gvtWt 5000(cuvP nvRvi) evsjv‡`k Z¨vMKv‡j Aev‡a
cÖZ¨vevmb‡hvM¨ nB‡e| †NvlYv cÖ`vb e¨wZ‡i‡K AvbxZ AbwaK gvtWt 5000(cuvP nvRvi) evsjv‡`kx bvMwiKM‡Yi
†ÿ‡ÎI m‡½ iÿY‡hvM¨ Ges evsjv‡`k nB‡Z ewn©MgbKv‡j m‡½ enb‡hvM¨ nB‡e; GZ`&wZwi³ †h †Kvb AsK
wbevmx evsjv‡`kx‡`i †ÿ‡Î evsjv‡`‡k AvMg‡bi 30(wÎk) w`‡bi g‡a¨ UvKvq fv½vB‡Z/cÖ‡hvR¨ ai‡Yi ˆe‡`wkK
gy`ªv wnmv‡e Rgv Kwi‡Z nB‡e| Awbevmx evsjv‡`kx KZ…©K AvbxZ GBiƒc AsK evsjv‡`‡k †diZ Avwmevi ci †h
†Kvb mgq UvKvq fv½vB‡Z cvwi‡eb A_ev ˆe‡`wkK gy`ªv wnmv‡e Rgv Kwi‡Z cvwi‡eb|
3. Encashment of foreign exchange brought in should be done with licenced Money Changers/
Authorised Dealer bank branches.

3| m‡½ AvbxZ ˆe‡`wkK gy`ªv UvKvq bM`vqb jvB‡mÝ cÖvß gvwb‡PÄvi/Aby‡gvw`Z wWjvi e¨vsK kvLvi gva¨‡g m¤úv`b
Kwi‡Z nB‡e|
4. An incoming/outgoing adult female passenger may bring in/take out any quantity of personal
jewellery worn on her person or as part of her accompanying personal baggage.

4| evsjv‡`‡k AvMgb/evsjv‡`k nB‡Z ewnM©gbKv‡j †Kvb cÖvß eq¯‹v gwnjv hvÎx ¯^xq cwiav‡b A_ev e¨w³MZ
e¨v‡M‡Ri Askiƒ‡c †h †Kvb cwigvY e¨w³MZ AjsKvivw` m‡½ Avwb‡Z/jBqv hvB‡Z cvwi‡eb|
See Chapter 7 Para 16 APP. 5 13

See Chapter 10 1(vii)(b), (ix)

FORM OF CERTIFICATE TO BE ISSUED BY THE AUTHORISED DEALER IN CASE OF


IMPORT ON FOB BASIS/SIMILAR OTHER PERMISSIBLE ARRANGEMENTS WHERE
TRANSPORTATION CHARGES ARE TO BE PAID IN BANGLADESH TAKA /OTHER
CURRENCY

CERTIFICATE

Certified that the amount of freight/transportation charges payable in..............................(currency

name with amount) Eqv. BDT.................. (Amount) as indicated in the Bill of Lading/ Airway

Bill No........................... dated the ............................................. corresponding House Bill of

Lading No/House Airway Bill No....................................dated the ............................in respect of

.........................................................................................................................imported by Messrs

...........................................................................from..............................................................per s.s

...................................................................................... has been duly endorsed on the Exchange

Monitoring Copy of the relative L.C. Authorisation Form No........................ dated the

......................................under our stamp and signature.

Signature of the bank official : ...................................................................................................


Name of the bank official : ...................................................................................................

Designation : ...................................................................................................
P.A No. : ...................................................................................................
Contact Phone No. : ...................................................................................................

Name of the AD : ...................................................................................................

Stamp of the AD : ...................................................................................................

Date : .............................................
See Chapter 7 Para 17 APP. 5 14

DECLARATION FOR IMPORT UNDER LCAF REGISTRATION


INFORMATION ABOUT IMPORT WITHOUT LC

1. LCAF issuing bank............................................ branch.................................... for import without LC

2. LCAF No. ....................................., Date...................................., Value.................................................

3. Name of the goods according to Purchase Contract/Purchase Order......................................................

HS Code Number ...................................................................................................................................

4. Value of Import Consignment ..................................................... Quantity ...........................................

5. Expected date of shipment........................................ Port of Loading ..................................................

6. Expected arrival date at Bangladeshi Port .............................................................................................

7. Condition for payment of Import Bill: DP/DA for .........................days from presentation/acceptance

Name and signature of the authorised Name and signature of the


person of the AD with date authorised person of the importer
See Chapter 7 Para 27 (i) APP. 5 15

BANGLADESH BANK
FOREIGN EXCHANGE POLICY DEPARTMENT

FORM OF UNDERTAKING

(To be furnished by the importer for making advance remittances for permissible imports of goods and services).

In consideration of Bangladesh Bank permitting me/us an advance remittance of


........................................to..........................................................I/we hereby undertake that the amount
so remitted by me/us will be used solely for the purpose of payment for the goods/services described
below to be imported into Bangladesh from ....................................in accordance with the regulations
in force regarding such imports. I/We declare that the goods/services will be imported by me/us on or
about ............................. and I/we undertake to produce to the Bangladesh Bank documentary
evidence in respect of goods/services so imported including the authenticated copy of the Customs
Bill of Entry for goods and supplier's invoice in original. I/We further declare that the amount paid by
me/us in advance will be deducted from the invoice value of the goods (CFR)/services imported and
that the deduction will be shown on the invoice.

Name and address Country of Particulars of


Invoice Value Description L.C. Authorisa-
of the supplier origin
tion Form

Goods Services Goods Services Goods Services Goods Services

Signature and Stamp of the Importer

Name of the Importer

Address

Registration Number with CCI & E

Signature and Stamp of the


Date ....................................... Authorised Dealer
See Chapter 7 Para 28(a) APP. 5 16

AD’s Code Serial No. Year Form IMP


IMP No. For Imports only
[Original copy for AD’s matching
FOREIGN EXCHANGE REGULATION ACT, 1947 with Authenticated Copy of Bill
Application for permission under Section 4/5 of the Foreign Exchange Regulation Act, 1947 of Entry/Customs certified invoice]
to purchase foreign exchange for payment of imports

Name and address of the Authorised Dealer effecting the remittance


I/We, the undersigned hereby apply for permission to remit
(Amount in foreign currency in figures and in words)
to
(Name and address of the beneficiary)

for goods imported/to be imported by us/me as per details given below against LC/Contract No…………..………….. Date: ……………………………

1 2 3 4 5 6
LC Authorization Form HS Quantity of goods Invoice value in foreign currency**
Registration No. Description
Value in Code Others, if any
Number Date with the AD of goods Unit Quantity FOB Freight Insurance Total
Taka No.* (Pls. specify)

7 8 9 10 11 12 13
Port of importation in
Country of Incoterm Port of Name of Steamer/Airlines and Indentor’s name Indentor’s Registration
Bangladesh or name of country
origin used Shipment date of shipment (if goods are and address No. with CCI&E
of ultimate destination if other
sent by post state so)
than Bangladesh

*For more than one HS Code, A separate sheet should be added.


** (a) ADs shall report FOB value, freight, insurance and other charges separately in Bangladesh Bank reporting system as per Circular Letter No. FEPD(Import)/125/2013-35 dated
December 10, 2013. (b) ADs shall report FOB value of goods in Schedule E-2/P-2 or relevant schedules, and freight, insurance and other charges in Schedule E-3/P-3 or other relevant
schedules mentioning IMP Form number. Contd …….. Page 2
See Chapter 7 Para 28(a) Page-2 APP. 5 16

1. I /We declare:
(a) That the above payment is due and that I/we have not already obtained exchange for payment of (any of) these goods, nor have I/we made
any other application for that purpose.
(b) The amount of Foreign Exchange mentioned above represents the correct prevailing market price for these goods on the date of contract in
country of Export.
(c) That I/we am/are neither connected with the exporters abroad directly or indirectly nor do I/we have any financial or other interest in the
exporters abroad.
2. I/We certify that the above import is covered by a valid L.C. Authorisation Form.
3. I/We undertake to clear the goods for consumption in Bangladesh within four months of the date of this application and shall, before the expiry of
that period, submit to your bank the authenticated copy/ies of the Customs’ Bills of Entry or certified invoice/s covering the above goods (See
note (a) below).
4. I/We declare that the statements made in this application are true to the best of my/our knowledge and belief.
5. I/We assume full responsibility for complying with the provisions of the Foreign Exchange Regulation Act, 1947 and rules, orders and directions
made or issued thereunder.
Full name and address of the applicant .....................................................................................................
Registration No. with C.C.I. &E ........................................................Date…………………………….... Signature and Stamp of the Importer
Importer’s VAT Registration (BIN) No…………...........……...….. Date………………………..……...

(This form shall be signed by the Importer or his authorised Agent)

(To be completed by the authorized Dealer)


1. We hereby certify that the statements made by the applicant in this form are to the best of our knowledge correct and that we have seen
documentary evidence in support thereof.
2. The remittance has been made in accordance with method of payment as per existing Foreign Exchange Regulations.

Date.................................. Signature and Stamp of the Authorised Dealer

Contd …….. Page 3


See Chapter 7 Para 28(a) Page-3 APP. 5 16

Bangladesh Bank Approval No. (if required)………………………………………………………………. Date …………………….............................…………………….

Approved for (Amount in words & figures)………………………………………………………………………...........................................................................................…

(Bangladesh Bank approval will remain valid for 30 days from the date of approval)

(CODING OF THE TRANSACTION BY AUTHORISED DEALER)


Country Receiving Country of origin of Quantity of goods Place of Type of
Month Commodity Currency Amount
Payment goods Unit Quantity importation LCAF

Coded by .......................................................

Checked by ....................................................
Date ............................................................... Signature and Stamp of the AD

NOTES FOR IMPORTERS: (PLEASE READ CAREFULLY)

(a) IMP Form is in one set. The importer should complete and sign the form and hand it over to the Authorised Dealer (Bank) through whom the remittance is being
made.

(b) The form should be completed in every required detail. There should be no alterations or deletions in the wording of the form except where provided. The form
should be signed by the Importer or his Authorised Agents holding Power of Attorney from the original importer. Importers are advised that a false statement on this
form constitutes an offence under Section 22 of the Foreign Exchange Regulation Act,1947. Omission of essential information constitutes a false declaration.
(c) The attention of Importers is drawn to sub-section 3 of the Section 4 of the Foreign Exchange Regulation Act, 1947. Exchange sanctioned for a particular purpose
must be utilised for that purpose only and all conditions attaching to the sanction must be complied with. If any of the prescribed conditions cannot be fulfilled and
as a result the exchange cannot be utilised in whole or in part for the purpose for which it was sanctioned, the unutilised amount must immediately be refunded
through an Authorised Dealer in foreign exchange in Bangladesh.
See Chapter 7 Para 31(c) APP. 5 17

……………………………..
(Name of the Bank)
STATEMENT OF CASES WITH MATERIAL DISCREPANCIES BETWEEN PARTICULARS IN IMPORT DOCUMENTS
AND IN THE AUTHENTICATED COPY OF BILL OF ENTRY/CUSTOMS CERTIFIED INVOICE
AS AT THE MONTH ENDED ON. .......................................

Importer IMP Form No. Item of Import Item of Import (As per Bill of Amount Remitted Month of return Details of discr. Whether taken Explanation
Branch name Importer (As per Import Documents Entry/Customs Certified Inv. LC no. Invoice Value schedule in which between particulars up with the
SL NO. & if any
HS HS Name of Amount Name of Amount transaction in the imp. doc. Importer (pl.
Name with full IRC No. AD submitted
(if any)

Serial Year Name Name Date and the copy of qoute letter
Remarks

reported to BB

loan/grant etc.)
Exchange (cash/
address Code No. Code Code Date Currency (Eqv. US$) Currency (Eqv. US$)

Source of Foreign
BOE/Cus. cer. Inv no.) by importer
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Total

We certify that all outstanding cases of material discrepancies in the import documents including those pending from the previous periods have
been listed in the above statement.

Name of the Official : ................................................................. Name of the Official : .................................................................

Designation : ................................................................. Designation : .................................................................

Contact No. : ................................................................. Contact No. : .................................................................


See Chapter 7 Para 31(c) APP. 5 18

……………………………..
(Name of the Bank)

STATEMENT OF NON-RECIPT OF AUTHENTICATED COPY OF BILL OF ENTRY/


CUSTOMS CERTIFIED INVOICE WITHIN DUE TIME AS AT THE MONTH ENDED ON. .......................................

Bill of Entry Overdue Month of


IMP Form No. Item of Import Invoice Value Amount Remitted Whether
Importer LC no. (If Received) Value return taken up Remarks
Branch schedule in with the
name with & which the

No.

SL No.
AD Name of Amount Name of Amount Name of Amount Amount Importer (if any)
overdue

Name Serial full HS


Reason for

Date (Eqv. Date (Eqv. transaction (pl. qoute


Code (Eqv. Currency (Eqv.

Name
No. Code
loan/grant etc.)

Year
Importer IRC
reported to
Exchange (cash/
Explana tion if any

address
Source of Foreign

Currency US$) Currency letter no.)


US$) US$) US$)
submitted by importer

BB
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
= (14-17)

Total

We certify that all outstanding cases of non-receipt of authenticated copy of bill of entry/customs certified invoice within the specified period
including cases pending from the previous periods have been listed in the above statement

Name of the Official : ................................................................. Name of the Official : .................................................................

Designation : ................................................................. Designation : .................................................................

Contact No. : ................................................................. Contact No. : .................................................................


See Chapter 7 Para 31 (c) APP. 5 19

……………………………..
(Name of the Bank)

SUMMARY STATEMENT OF NON-RECIPT OF AUTHENTICATED COPY


OF BILL OF ENTRY/CUSTOMS CERTIFIED INVOICE WITHIN DUE TIME
AS AT THE MONTH ENDED ON. .......................................

No. of
SL Overdue Branch Overdue Amount against Bill Of Remarks
Bill(s) of
No. Year Name Entry (if any)
Entry
Name of Equivalent
Currency Amount
U.S.Dollar

1 2 3 4 5 6 7 8

Total

We certify that all outstanding cases of non-receipt of authenticated copy of bill of


entry/customs certified invoice within the specified period including cases pending from
the previous periods have been summarised in the above statement.

Name of the Official : ......................................... Name of the Official : .........................................

Designation : ...................................................... Designation : ......................................................

Contact No. : ..................................................... Contact No. : .....................................................

Note : Branch having overdue BoEs in more than one currency in a particular month/year shall
use required no of rows for reporting

Cont.. Page-2
See Chapter 7 Para 31 (c) APP. 5 19

Page-2

INSTRUCTIONS REGARDING SUBMISSION OF STATEMENT OF NON-RECEIPT


OF AUTHENTICATED COPY OF BILL OF ENTRY/CUSTOMS CERTIFIED
INVOICE AS PER APPENDICES 5/18 AND 5/19

1. Consolidated information of 'Overdue Bills of Entry (both full and partial)' should be
submitted in above mentioned statements which shall be submitted (softcopy to
[email protected]) within 10th day of the following month. Late submission of the same
may invite financial penalty in accordance with Section 36(6) of the Bangladesh Bank Order,
1972.
2. Subject line of the e-mail for submission of the above statements would be as follows:

"Monthly Statement of Overdue Bills of Entry for the month <month_name>,<year> of


<bank_name>"
3. The statements should be provided in the excel files.
4. The files must contain name of the bank and name of month on the upper portion as well as
names, designations, and contact nos. of two responsible officials (one maker, one checker) at
the lower portion.
5. The information must contain uniformity with the following reports of the Online Import
Monitoring System:
a. Overdue Bill of Entry Information and
b. Overdue (Partial) with less Bill of Entry Amount of matched IMPs.
6. If any supporting documents (waiver from non submission of bill of entry, time
extension for, submission of bill of entry) are required with these statements, attested scanned
copy of those doucments should be attached with the same mail.
See Chapter 7 Para 33 (e) APP. 5 20

Form- BC

MONTHLY STATEMENT ON USE OF BUYERS' CREDIT IN FOREIGN EXCHANGE

Name of Bank...............................................
Month and year ............................................
Part – A

Borrowing cost
Name and Name of AD Amount of Name and
Sl. address of the Item of bank branch buyer’s credit Interest rate All in cost address of Due date(s) of
No. borrower- import handling the and date of (percent per (percent per annum) fx fund repayment
importer buyer’s credit drawal annum) including other provider
charges
1 2 3 4 5 6 7 8 9

Part – B
1. Total outstanding buyer’s credit as at close of preceding month, in USD equivalent:
2. Total amount of new buyer’s credit drawn during the reporting month, in USD equivalent:
3. Total repayments during the reporting month, in USD equivalent:
4. Outstanding at the close of the reporting month, in USD equivalent
(i) total amount :
(ii) of which overdue:
(iii) reasons for overdue situation mentioned at (ii) above, steps taken towards adjustment:

Signature of Authorised Official .........................................


Official Seal Name: ...................................................................................
Designation: ..........................................................................
th
(To be submitted by the 15 day of the next month) Date: .....................................................................................
See Chapter 7 Para 34(b)(i) APP. 5 21

MONTHLY SUMMARY STATEMENT OF OVERDUE ACCEPTED BILLS


FOR THE MONTH OF .............................................

Bank Name ........................................................................................................................................

Bill value in
Sl Nature of bills Number of bills equivalent USD Remarks

Local Payables
1
(excluding court case)
Unpaid Local Bills due to
2
court case

3 Total Local Payables (1+2)

Foreign Payables
4
(excluding court case)
Unpaid Foreign Bills
5
due to court case
Total Foreign Payables
6
(4+5)

Local Receivables
7
(excluding court case)
Local Bills not received
8
due to court case
Total Local Receivables
9
(7+8)

Name of Authorised Personnel : ........................ Name of Authorised Personnel : ........................

Designation : ...................................................... Designation : ......................................................

Contact Number : ............................................... Contact Number : ...............................................


See Chapter 7 Para 34 (b)(ii) APP. 5 22

MONTHLY STATEMENT OF OVERDUE ACCEPTED BILLS (LOCAL PAYABLES)


FOR THE MONTH OF ............................................................

Bank Name : ............................................................................................................................................................................................................................

Name of LC/ LC/ Name of the Bill


LC/ Quoted Contract Quoted Date of Bill Date of Date of Delay Name of Name of Reason Comments
Sl. the LC Contract LC Advising Value for
Bill No. Currency (in quoted (dd/mm/yy) Acceptance Maturity Days the the
No Issuing Contract Currency Value (in date Bank & (dd/mm/yy) (dd/mm/yy) Importer Exporter Overdue (if any)
Branch Number quoted currency)
currency) (dd/mm/yy) Branch

Total In Quoted Currency X =


Total In Quoted Currency Y =
Grand Total (in equivalent USD) =

Name of Authorised Personnel : .............................................. Name of Authorised Personnel : ..............................................


Designation : .............................................................................. Designation : ..............................................................................
Contact Number : ...................................................................... Contact Number : ......................................................................
See Chapter 7 Para 34 (b)(iii) APP. 5 23

MONTHLY STATEMENT OF OVERDUE ACCEPTED BILLS (FOREIGN PAYABLES)


FOR THE MONTH OF ............................................................

Bank Name : ............................................................................................................................................................................................................................


LC/ Bill
Name of Date of Date of Delay Name of Name of Reason
Sl. the LC LC/ Quoted Contract LC/ Contract Name of the Quoted Value Date of Bill Acceptance Maturity Days Comments
Value (in date LC Advising Bill No. the the for
No Issuing Contract Currency
Bank & Currency (in quoted (dd/mm/yy) (if any)
Number quoted (dd/mm/yy) (dd/mm/yy) (dd/mm/yy) Importer Exporter Overdue
Branch currency) Branch currency)

Total In Quoted Currency X =


Total In Quoted Currency Y =
Grand Total (in equivalent USD) =

Name of Authorised Personnel : .............................................. Name of Authorised Personnel : ..............................................


Designation : .............................................................................. Designation : ..............................................................................
Contact Number : ...................................................................... Contact Number : ......................................................................
See Chapter 7 Para 34 (b)(iv) APP. 5 24

MONTHLY STATEMENT OF OVERDUE ACCEPTED BILLS (LOCAL RECEIVABLES)


FOR THE MONTH OF ............................................................

Bank Name : ............................................................................................................................................................................................................................


Name of LC / Name of the Bill Date of Date of Name of Name of Reason
Sl. the LC LC / Quoted Contract LC / Contract LC Advising
Contract date Bill No. Quoted Value Date of Bill Acceptance Maturity Delay the the for Comments
No Issuing Currency Value (in Days
Currency (in quoted (dd/mm/yy) (dd/mm/yy) (dd/mm/yy) (if any)
Bank & Number quoted (dd/mm/yy) Bank & Importer Exporter Overdue
Branch currency) Branch currency)

Total In Quoted Currency X =


Total In Quoted Currency Y =
Grand Total (in equivalent USD) =

Name of Authorised Personnel : .............................................. Name of Authorised Personnel : ..............................................


Designation : .............................................................................. Designation : ..............................................................................
Contact Number : ...................................................................... Contact Number : ......................................................................
See Chapter 7 Para 34 (b)(v) APP. 5 25

Page-01

MONTHLY BANK-WISE SUMMARY STATEMENT OF LOCAL OVERDUE


ACCEPTED BILLS FOR THE MONTH OF ............................................................

Bank Name : ......................................................................................................................................

Local Bills Payable Local Bills Receivable


Sl No.

Name of the Banks


Number Value(equv. USD) Number Value(equv. USD)
Total

Name of Authorised Personnel : Name of Authorised Personnel :


Designation : ................................. Designation : ..................................
Contact Number :.......................... Contact Number : ...........................
See Chapter 7 Para 34(b)(i-v) Page-02 APP. 5 25

INSTRUCTIONS FOR PREPARING MONTHLY STATEMENTS OF OVERDUE


ACCEPTED BILLS (APPENDIX 5/21-5/25)

1. The statements shall contain all the accepted overdue bills (under LC/contract) that remained
unpaid/not received till the end of each month.
2. Softcopy of each month's statement in excel format should be mailed to Bangladesh Bank
(FEOD, Head Office) by the 15th of next month positively unless otherwise instructed or
exempted. If the 15th of next month falls on a non-business day, then it will be due by the
next working day. Delay in submission may result in penalty in accordance with Section
36(6) of the Bangladesh Bank Order 1972 (President's Order No 127 of 1972).
3. The mail should be sent ONLY to the mail address of Import Trade section, FEOD,
Bangladesh Bank ([email protected]) unless otherwise instructed. Official E-mail ID
must be used while sending the mail.
4. The subject line of the email should be maintained as: Monthly Statement of Overdue
Accepted Bills (App 5/21-5/25) for the Month of ___.
5. The body of the email must include the sender's name, designation, department, bank name,
contact number and email address.
6. In the 'Local Payables', 'Foreign Payables', 'Local Receivables' statements all columns should
be filled properly according to the column headings. For court cases, latest update of the case
(e.g. stay order up to which date, next hearing date etc.) should be mentioned in the
'Comments' column.
7. In 'Summary' and 'Bank-wise Summary' statements, no cells in the number/value columns
should be left blank. In case of no value, '0'/'-' should be put in those cells. In case of nil
statement, 'NIL' should be written in the body of the statement.
8. All the statements must contain name, designation and contact number of two officials (one
maker, one checker) of the concerned bank.
9. Hardcopy of the statement along with the body of the sent email should be printed and
preserved with the AD banks for eventual inspection by Bangladesh Bank.
10. If any supporting documents are required with these statements, attested scanned copy of
those documents should be attached with the same email.
See Chapter 7 Para 42(ii) APP 5 26

MONTHLY STATEMENT OF RETENTION AND USE OF FOREIGN EXCHANGE RECEIVED FROM


DIRECT/DEEMED EXPORT FOR PAYMENT OF IMPORT LIABILITIES FOR THE MONTH OF ...............

..............................................................................................................Bank ...............................................................................................................Branch

Name and Foreign exchange Balance of Amount of Amount of foreign exchange retained Closing balance of
address received from unutilised portion foreign exchange but not used for payment of import foreign
of the direct/deemed of foreign exchange
utilised from column bill within 30 days of receipts exchange retained
export in the nos. 2 and 3 for as on the end of
exporting firm retained from
month under payment of month {(2+3)-
direct/deemed
repor t import bill during (4+5+6)
export of the
the month under
previous month for
report
payment of import
bills

Amount Credit to
encashed Retention Quota
Account

1 2 3 4 5 6 7

Name and signature of the authorised person


Date : ..................................................................
See Chapter 7 Para 42 (ii) APP 5 27

MONTHLY STATEMENT OF RETENTION AND USE OF FOREIGN EXCHANGE RECEIVED FROM DIRECT/DEEMED
EXPORT FOR PAYMENT OF IMPORT LIABILITIES FOR THE MONTH OF ..............

....................................................................................................................................................................................................................Bank, Head Office

Foreign exchange Balance of Amount of Amount of foreign exchange retained Closing balance of
received from unutilised portion foreign exchange but not used for payment of import foreign
direct/deemed utilised from column bill within 30 days of receipts exchange retained
of foreign exchange
export in the nos. 1 and 2 for as on the end of
retained from
month under payment of month {(1+2)-
direct/deemed
repor t import bill during (3+4+5)
export of the
the month under
previous month for
report
payment of import
bills

Amount Credit to
encashed Retention Quota
Account

1 2 3 4 5 6

Name and signature of the authorised person


Date : .............................................................
See Chapter 7 Para 47 (ii)(a) APP 5 28

STATEMENT OF L/Cs OPENED UNDER LOANS/CREDITS/GRANTS


REQUIRING DEPOSITS OF COUNTERPART TAKA FOR THE MONTH
OF ............................................................

Name of the Designated Bank .............................................................................................................................................................................................................

SI. L/C No. Name & Identifying name Amount of L/C opened. Last date of Probable Indicate the Any
No & address of of shipment date of arrangements other
Date importer Loan/credit/grant In foreign In Bangladesh under the receipt of made with remarks
under which L/C currency Taka L/C import importer for
was opened document deposit of
in Counterpart Funds
Bangladesh on receipt of
import documents.
1 2 3 4 5 6 7 8 9 10

(To be submitted to the Bangladesh Bank by the 15th of every month).

Seal & Signature of the Designated Bank


Date : .........................................................
See Chapter 7 Para 47 (ii)(b) APP 5 29

STATEMENT OF DISCREPANT BILLS RFCEIVED ON COLLECTION BASIS

SI Name & Name & Bill No. Identification Description Date of Date of Bill Amount
No. Address of the address of & date of the loan/ of goods receipt of acceptance
importer importer's credit/grant the of
bank document document Foreign Rate of Bangladesh
by currency exchange Taka
designated applied
bank

1 2 3 4 5 6 7 8 9 10 11

Signature & Seal of the


Date ............................. Designated Bank
See Chapter 7 Para 47 (iii) APP 5 30

SATEMENT OF DEPOSIT OF COUNTERPART TAKA FUNDS.

SI. Name and L/C No. Identificaton Description Date of Date of Bill No. *Bill amount Date of Reasons for
No. address & Date of the of goods negotiation receipt of & date deposit of delay, if
of the Loan/ of bills/ document Foreign Rate of Bangladesh counterpart any, in
importer Credit document in Currency exchange Taka depositing
Grant Bangladesh Taka funds counterpart
applied Taka funds

1 2 3 4 5 6 7 8 9 10 1 12 13

* If forward cover is taken, indicate the month in which the forward sale has been reported as per para 8 of Chapter- 4, section-II of this Guidelines

Date ............................. .
Signature & Seal of the
Designated Bank
See Chapter 8 Para 4 APP 5 31

(Statutory declaration to be furnished by First Original


exporters under FE Regulation Act, 1947
EXP FORM (To be submitted to the Customs with
before shipment of goods. An incorrect
declaration constitutes offence under the Second Original duly completed and certified
said Act.) by the Authorised Dealers)

AD’s Code Serial Number Serial Year


EXP NO.

Name and address of the Authorised Dealer


I/We, the undersigned hereby declare that I/we am/are the sellers/consignors of the goods described below in respect
of which this declaration is made out and that the particulars given in the following items are true and that the invoice
value declared in SI.No.5 in case of firm contract is full value as contracted with the buyers; and in case of
consignment sale, is a fair value of the goods which are being shipped on consignment sale.
I/We do hereby undertake to repatriate full proceeds of the export within the period specified by the Bangladesh Bank in
terms of FER Act.

Sl. Particulars (to be Code No. (to be filled in


Items
No filled in by Exporter) by Authorised Dealer)

1. Commodity to be exported
2. Country of destination
3. Port of destination
Unit (bales/tons/lbs. etc.)
4. Quantity
Volume (Weight/number etc.)
Currency
Incoterm Used
5. Value FOB Insurance Freight
Invoice Value

CMT Value (if applicable)


6. Terms of sale (Firm Contract/LC or
Consignment sale)
7. Name & address of importer/consignee
8. Name of carrying vessel
9. Bill of Lading/Railway Receipt/Airway No.:
Bill/Truck Receipt/Post Parcel Receipt Date:
10. Port of shipment/Post Office of despatch
11. Land Custom Post
12. Shipment date
13. Name of the Exporter (in block letter) with
address
14. CCI&E’s Registration Number of the
exporter and date
15. Sector (Public or Private) under which the
exporter falls

Coded by ............................................................
Checked by ........................................................
Authorised Signature and Stamp
of the Exporter with date (Signature of authorised official of the bank)

Cont’d …………………P/2
Page-2
See Chapter 8 Para 4 APP 5 31

CERTIFICATE OF AUTHORISED DEALER


Certified that the above exporter(s) is/are known to us, that he/they is/are bonafide businessman/men
in Bangladesh and that he/they has/have made arrangements with us for the realisation of the export
proceeds of the goods declared on this form within the stipulated period and that we are satisfied with
the said arrangements. We have also satisfied ourselves about the bonafides of the importers/consignees
abroad and their credentials etc.
*We undertake that for export shipments on consignment sale, we shall obtain from the exporter(s) and
furnish to the Bangladesh Bank a fully documented account sale certified by the consignees/Chamber of
Commerce of the country of import.
*We further undertake that in the event of non-realisation or short realisation of export proceeds
against shipment within the stipulated period, we shall obtain from the exporter(s) and furnish to the
Bangladesh Bank full explanation as to the circumstances resulting in non-realisation/short realisation.
*(Strike out the portion not applicable and authenticate with initials).

Date Stamp and Signature of


Authorised Dealer

(TO BE COMPLETED BY CUSTOMS/POST OFFICE)


1. Month in which this item is included in the Customs/Post Office Return
2. Value assessed by the Customs/Post Office
3. Shipping Bill/Airway Bill/Post Parcel Receipt No Dt.

Seal Signature of Custom Officer


Date

CERTIFICATE BY AUTHORISED DEALER


(Applicable where advance payment or irrevocable or confirmed Letter of Credit is required in cover of
the shipment.)
1. An irrevocable/confirmed Letter of Credit No.
for on has been opened covering the shipment described on page No. 1.
2. Remittance for has been received as per method No. as indicated below on
and has been allocated against the shipment described on page No. 1.
(i) in Taka from a Non -Resident Bank A/C.
(ii) in Foreign Currency on Amount
(State Currency)
Signature and Stamp of
Date Authorised Dealer
See Chapter 8 Para 4 APP 5 31

(Statutory declaration to be furnished by Second Original


exporters under FE Regulation Act, 1947
EXP FORM (To be returned to the Authorised Dealer
before shipment of goods. An incorrect
within 14 days from the date of shipment
declaration constitutes offence under the
along with customs certificaton and relative
said Act.) documents for negotiation)

AD’s Code Serial Number Serial Year


EXP NO.

Name and address of the Authorised Dealer


I/We, the undersigned hereby declare that I/we am/are the sellers/consignors of the goods described below in respect
of which this declaration is made out and that the particulars given in the following items are true and that the invoice
value declared in SI.No.5 in case of firm contract is full value as contracted with the buyers; and in case of
consignment sale, is a fair value of the goods which are being shipped on consignment sale.
I/We do hereby undertake to repatriate full proceeds of the export within the period specified by the Bangladesh Bank in
terms of FER Act.

Sl. Particulars (to be Code No. (to be filled in


Items
No filled in by Exporter) by Authorised Dealer)

1. Commodity to be exported
2. Country of destination
3. Port of destination
Unit (bales/tons/lbs. etc.)
4. Quantity
Volume (Weight/number etc.)
Currency
Incoterm Used
5. Value FOB Insurance Freight
Invoice Value

CMT Value (if applicable)


6. Terms of sale (Firm Contract/LC or
Consignment sale)
7. Name & address of importer/consignee
8. Name of carrying vessel
9. Bill of Lading/Railway Receipt/Airway No.:
Bill/Truck Receipt/Post Parcel Receipt Date:
10. Port of shipment/Post Office of despatch
11. Land Custom Post
12. Shipment date
13. Name of the Exporter (in block letter) with
address
14. CCI&E’s Registration Number of the
exporter and date
15. Sector (Public or Private) under which the
exporter falls

Coded by ............................................................
Checked by ........................................................
Authorised Signature and Stamp
of the Exporter with date (Signature of authorised official of the bank)

Cont’d …………………P/2
Page-2
See Chapter 8 Para 4 APP 5 31

CERTIFICATE OF AUTHORISED DEALER


Certified that the above exporter(s) is/are known to us, that he/they is/are bonafide businessman/men
in Bangladesh and that he/they has/have made arrangements with us for the realisation of the export
proceeds of the goods declared on this form within the stipulated period and that we are satisfied with
the said arrangements. We have also satisfied ourselves about the bonafides of the importers/consignees
abroad and their credentials etc.
*We undertake that for export shipments on consignment sale, we shall obtain from the exporter(s) and
furnish to the Bangladesh Bank a fully documented account sale certified by the consignees/Chamber of
Commerce of the country of import.
*We further undertake that in the event of non-realisation or short realisation of export proceeds
against shipment within the stipulated period, we shall obtain from the exporter(s) and furnish to the
Bangladesh Bank full explanation as to the circumstances resulting in non-realisation/short realisation.
*(Strike out the portion not applicable and authenticate with initials).

Date Stamp and Signature of


Authorised Dealer

(TO BE COMPLETED BY CUSTOMS/POST OFFICE)


1. Month in which this item is included in the Customs/Post Office Return
2. Value assessed by the Customs/Post Office
3. Shipping Bill/Airway Bill/Post Parcel Receipt No Dt.

Seal Signature of Custom Officer


Date

CERTIFICATE BY AUTHORISED DEALER


(Applicable where advance payment or irrevocable or confirmed Letter of Credit is required in cover of
the shipment.)
1. An irrevocable/confirmed Letter of Credit No.
for on has been opened covering the shipment described on page No. 1.
2. Remittance for has been received as per method No. as indicated below on
and has been allocated against the shipment described on page No. 1.
(i) in Taka from a Non -Resident Bank A/C.
(ii) in Foreign Currency on Amount
(State Currency)
Signature and Stamp of
Date Authorised Dealer
See Chapter 8 Para 7(a) APP 5 32

EXPORT REGISTER

SI Number of Name and address Amount declared on Date of Initials of Date of


Commodity the certifying Bill No.
No. EXP Form of the exporter EXP Form certification shipment
officials
1 2 3 4 5 6 7 8 9

Date of negotiation or Date of reporting of Date of Amount realised in Taka amount paid Date of reporting of
sending abroad for collection Second Original to BB realisation foreign currency to the exporter and
realisation to BB online
of export proceeds online rate of exchange applied

10 11 12 13 14 15
See Chapter 8 Para 11(a) APP 5 33

(To be typed in AD's letter-head)

INFORMATION RELATING TO EXPORT ORDERS WITH FOREIGN AGENT COMMISSION


EXCEEDING PERMISSIBLE LIMIT FOR WHICH APPROVAL IS REQUIRED

A. Statement of export:

Export LC/ Terms of Payment Usance Remarks


Sl. Name of Contract
Last Date
Value of Expiry Inco Agent Discount
Date Terms Commission Usance
No Importer No. with in FC Shipment (in %) Sight (period) Rate*
date
1 2 3 4 5 6 7 8 9 10 11 12

*in case of export bill to be discounted at sight


B. Calculation of value addition (Net FOB export value less input contents, both foreign and local)
for each export LC/contract as per above A.
(Please use separate sheet if necessary.)

C. Export performance of the exporter for the last 3 years:

Bill value Repatriated value Rate of realisation Agent commission Outstanding/Overdue


Year
(in FC) (in FC) (in %) settlement (in FC) (in FC)

1 2 3 4 5 6

Declaration of Authorised Dealer

We do hereby declare that the above statements depict the true information in accordance with documentary
records/evidences. We shall be held responsible for wrong information, if any. We shall make available the
documents as and when required by Bangladesh Bank/its inspection team. Necessary arrangements are in place
to repatriate the export proceeds within the stipulated time.

Signature : ...................................................... Signature : ......................................................


Name : ............................................................ Name : ............................................................
Designation: Head of export Designation: Head of branch/trade operation
PA Number : .................................................. PA Number : ..................................................
Date : .............................................................. Date : ..............................................................
OFFICIAL
STAMP
See Chapter 8 Para 15(a) APP 5 34

MONTHLY STATEMENT OF OUTSTANDING EXPORT BILLS


Position as on ............................................................(last day of month under report) ....................................
(To be submitted within 10th day of the month following that to which relates)
(Taka in Crore)
Value of Value of Total
sight bills usance bills
1. Value of Outstanding Export Bills as on the last
day of previous month
2. Value of all export bills purchased or sent on
collection basis during the month under report
3. Export proceeds realised during the month under
report against bills mentioned in items Nos. 1 & 2
4. Total outstanding export bills as on the last day of
the month under report:
a) Export proceeds due against all bills received
from customers on collection basis
b) All export bills purchased from customers for
which proceeds not yet credited to Authorised
Dealer's account abroad
Total (a + b):

Monthly maturity position of the total outstanding Against current Against overdue
Export b ills bills bills
1st month following the month under report

2nd month following the month under report

3rd month following the month under report

4th month following the month under report

5th month following the month uinder report

6th month following the month under report

After 6th month following the month under report


Total:
No. of Bills

Stamp and Signature of the Authorised Dealer


See Chapter 8 Para 15(b) APP 5 35

See Chapter 8 Para 23(c)

STATEMENT OF PARTICULARS OF EXPORT BILLS OUTSTANDING BEYOND THE PRESCRIBED PERIOD OF REALISATION AS
AT (END OF MONTH UNDER REPORT)
Part I : Export bills outstanding other than those covered under Parts II & III below :

SI. Bill No. Name & address of Date of EXP Nature of bill drawn
Destination Commodity
No. and date exporter export Form No DP/DA)

1 2 3 4 5 6 7 8

Amount actually Reasons for Cross reference


Amount realised Remarks
Invoice Value outstanding non-realisation to original entry in
(currency)
(9 -10) of the outstandings case of deletion
9 10 11 12 13 14

Note: Please fill in only columns 1,2, 3, 5, 9, 10 and 13 in respect of deletions which should be grouped together.

Part II : Exports on consignment basis outstanding

Details as per Part-I

Note : Please fill in only columns 1, 2, 3, 5, 9, 10 and 13 in respect of deletions which should be grouped together.

...................Contd.......P/2
See Chapter 8 Para 15(b) APP 5 35

See Chapter 8 Para 23(c) Page-2

PART : III UNDRAWN BALANCES OUTSTANDING

SI Name and address of Total amount Remark


No. the Exporter outstanding
1 2 3 4

See item No. (iv) of instructions for completing the statement

Note : Please complete additions and deletions separately and fill up all the columns.

...................Contd.......P/3
See Chapter 8 Para 15(b) APP 5 35

See Chapter 8 Para 23(c) Page-3

PART : IV : SUMMARY

Outstanding as on Tk
(end of previous month)

Add : Additions during the month Tk


under report

Less : Deletions during the month Tk


under report

Net position of outstandings


as on Tk
(end of month under report)

We certify that all export bills outstanding beyond the prescribed period of realisation as at the end of month under report have been included in this
statement.

Place

Date Signature and Stamp of Authorised Dealer

....................Contd. ....................P/4
See Chapter 8 Para 15(b) APP 5 35

See Chapter 8 Para 23(c) Page-4

INSTRUCTION FOR COMPLETING STATEMENT

(i) Authorised Dealers should submit a consolidated statement giving details of all export bills
outstanding beyond the prescribed period of realisation as at the end of each month giving details of
additions and deletions of outstanding export bills during the relative month. All additions should
be grouped together and shown first and all deletions grouped together and shown later. Net
position of outstanding export bills included in parts I to III of the statement should be given in part
IV of the statement.

(ii) In part I, particulars of all outstanding export bills other than undrawn balance and exports on
consignment basis should be included.

(iii) In part II, particulars of all outstandings as in part I, in respect of exports on consignment basis
should be reported (although no bills have been drawn) in this part.

(iv) In part III, only exporter-wise totals of undrawn balances outstanding need be reported in the
statements. Full particulars of those bills as in part-I should be reported in this part.

(v) In part-IV net position of outstanding export bills included in parts I to III of the statement are to be
given in this part.

(vi) Exporter-wise totals/grand totals (converted into Taka wherever necessary) should be given.

(vii) Advance remittances and part realisations should be shown under the column "Amount realised"
and the balance shown as outstanding.

(viii) Approval number and date of the Bangladesh Bank and the date upto which extension has been
given should invariably be indicated in "Remarks" column. Where approval for extension of time
has not been obtained from the Bangladesh Bank, steps taken in that regard should be indicated in
"Remarks" column.

(ix) In cases where export proceeds against EXP Forms have been un-realised either in full or in part
because legal proceedings have been initiated against the buyers a suitable remarks should be made
in the statements.

(x) Outstanding in respect of which proceeds are not recoverable but which are being reported only for
technical reasons should be distinctly denoted quoting Bangladesh Bank's reference and date in
terms of which the item is required to be reported as outstanding.
See Chapter 8 Para 22 APP 5 36

EXPORT PROCEED REALISATION CERTIFICATE AGAINST DIRECT EXPORTS

Name and address of the Exporter ............................... ERC No. ................ PRC Issued For........................PRC No...........................Date...................................

Amount Realised Net FOB value Reference of the


Description B/L No. & Date Invoice 1. Freight paid
EXP Date of Schedule/Statement in
of and Country of value 2. Commission
No. Foreign Bangladesh Realisation Foreign Bangladesh which Transaction has
No. & 3. Insurance
Commodity Destination Currency Taka Currency Taka been or will be Reported
Exported Date
to Bangladesh Bank

1 2 3 4 5 6 7 8 9 10 11

We hereby certify that the particulars mentioned above are correct. We also undertake that in case any discrepancy in regard to the transactions
mentioned in this certificate is detected, we shall remain responsible for the same and shall abide by any decision taken by the Bangladesh Bank in this
regard. We further undertake that if any insurance and other export claims relating to the export indicated in the Proceed Realisation Certificate arises,
we shall abide by any decision of the Bangladesh Bank for deduction of appropriate amount from any future Proceed Realisation Certificate. We will
send the 'Verification Copy' of the PRC to Bangladesh Bank for post facto checking in the month of ...................................................

Signature of the head of the branch : .......................................................... Signature of the issuing officer of the branch : ..........................................
Full name : .................................................................................................. Full name : ...................................................................................................
Designation: ................................................................................................ Designation: ................................................................................................
PA No. :....................................................................................................... PA No. :........................................................................................................
Phone No. :................................................................................................. Phone No. :...................................................................................................

Seal : ............................................ Date :.............................................. ... Seal : ............................................ Date :.....................................................


See Chapter 8 Para 22 APP 5 37

EXPORT PROCEED REALISATION CERTIFICATE AGAINST DEEMED EXPORTS

Name and address of the Exporter .......................... ERC No.................... PRC Issued For...........................PRC No..........................Date.......................

Back To Back L/C Local Concerned Master Export LC/Contract Commodity


LC/Contract Ref. in regard to Bill Reference Realised Bill Value Reporting Reference
which PRC is being Issued Reference Date of Realisation to Bangladesh Bank

No. Date Value No. Date Value No. Date Currency Amount
(FC) Value (FC)
(FC)
1 2 3 4 5 6 7 8 9 10 11 12 13 14

We hereby certify that the particulars mentioned above are correct. We also undertake that in case any discrepancy in regard to the transactions mentioned
in this certificate is detected, we shall remain responsible for the same and shall abide by any decision taken by the Bangladesh Bank in this regard. We
further undertake that if any insurance and other export claims relating to the export indicated in the Proceed Realisation Certificate arises, we shall abide
by any decision of the Bangladesh Bank for deduction of appropriate amount from any future Proceed Realisation Certificate. We will send the
'Verification Copy' of the PRC to Bangladesh Bank for post facto checking in the month of ...................................................
Signature of the head of the branch : .......................................................... Signature of the issuing officer : ...........................................................
Full name : .................................................................................................. Full name : ...................................................................................................
Designation: ................................................................................................ Designation: ................................................................................................
PA No. :....................................................................................................... PA No. :........................................................................................................
Phone No. :................................................................................................. Phone No. :...................................................................................................

Seal : ............................................ Date :.............................................. ... Seal : ............................................ Date :.....................................................


See Chapter 8 Para 25 (d) APP 5 38

MONTHLY STATEMENT OF DISCOUNTING OF DIRECT/DEEMED EXPORT BILLS IN FOREIGN EXCHANGE


Period : ...................................... Month :............................................Year: .................................
Part A :

Name and Discounted Date of AD branch Fx fund Other


address of value net of discounting transacting source for remarks, if
the payee Bill value and due date charges and the the any
direct and fees discounting discounting
deemed
exporter
1 2 3 4 5 6 7 8

Part B :
i) Total outstanding value of bills discounted in foreign exchange by all AD branches of the bank:
ii) Out of amount in (i), the amount overdue for adjustment if any:
iii) Reasons for overdue situation mentioned at ( ii), steps towards adjustment:

Signature of the authorised official


Name : ..........................................................................................
Designation : ................................................................................
Official Seal : ............................................................... Contact Phone No. .....................................................................
E-mail : ........................................................................................
Date : ...........................................................................................
See Chapter 9 Para 2 APP 5 39

Name of the Bank : ..................................... Branch/Department : .....................................

Serial No....................................................... Date of issue : ................................................

CERTIFICATE OF AUTHORISED DEALER

This is to certify that we have made following payment by debit to Non-Resident Taka Accounts
maintained and fed in foreign currency by ...................................................... (overseas branches and
correspondents) for purchase of shares in ............................................................................. (company):

(a) Ordering remitter of overseas branches and correspondents ............................................................

(b) Country..............................................................................................................................................

(c) Beneficiary........................................................................................................................................

(d) Address..............................................................................................................................................

(e) Amount in Taka ................................................................................................................................

(f) Date of payment................................................................................................................................

(g) Mode of payment ..............................................................................................................................

(h) Reporting statement/schedule (check/pay order/bank transfer etc.) to BB with month ...................

...................................................................................................................................................................

Signature: .............................................................................
Name of authorised official: ................................................
Designation: .........................................................................
Seal: ......................................................................................
Date: .....................................................................................
See Chapter 9 Para 2 APP 5 40

Name of the Bank : ..................................... Branch/Department : .....................................

Serial No....................................................... Date of issue : ................................................:

CERTIFICATE OF AUTHORISED DEALER

This is to certify that we have received following inward remittance for purchase of shares in
.............................................................................................................................................. (company) :

(a) Remitter................................................... (b) Country....................................................................


(c) Beneficiary.............................................. (d) Address...................................................................

(e) Amount in FC......................................... (f) Date of receipt.........................................................

(g) Equivalent Taka .................................... (h) Credited to Account with date................................


(i) Type of Account..................................... (j) Reporting statement/ schedule to BB with
month..................................................................

Signature: .............................................................................
Name of authorised official: ................................................
Designation: .........................................................................
Seal: ......................................................................................
Date: .....................................................................................
See Chapter 9 Para 12 APP 5 41

FOREIGN EXCHANGE REGULATION ACT, 1947

(Return of Securities required to be submitted under Section 19(l) of FER Act, 1947)

(a) Full name and address of the owner by whom or on whose behalf the return is made ...........................
..................................................................................................................................................................

(b) Description of the Security in full, including particulars as to whether it is a bearer bond, registered
or inscribed stock etc. ..............................................................................................................................

(c) Nominal amount of the Security ..............................................................................................................

(d) Whether the Security is free or encumbered and if the latter, full details of the nature of the encumbrance
including the amount of loans or advances, if any, which have been taken against the security and the
currency in which and the names and addresses of the persons from whom they have been taken ..........
.........................................................................................................................................................................

(e) Place in which and name of the person with whom the security is deposited .........................................

(f) Full name and address of the person for whose account the security is held (in case a person other
than the owner is making the return) .......................................................................................................

Signature of owner or agent


(Full name and Address)

Stamp of the bank or stock-broker Place .............................................


through whom the return is lodged
with Bangladesh Bank. Date ..............................................

Note: This return (original and duplicate both completed) may be submitted to the Bangladesh Bank
either direct at any of its offices or through any bank or recognised stock-broker. In the latter
case, the bank or broker will stamp the return with his name A separate form must be used for
each security.
See Chapter 10 Para 1 (i) APP 5 42

FORM FP
FORM OF DECLARATION TO BE FURNISHED BY SHIPPING/AIRLINE CO./AGENT WHEN
APPLYING FOR REMITTANCE OF SURPLUS FREIGHT AND PASSAGE MONEY DUE TO
FOREIGN OWNERS OR OPERATORS
Foreign Exchange Regulation Act, 1947.
Remittance of A/C S.S/ Airline
(Amount)
to M/s of
(Ship owners or operators) (Address)
We agent for the above vessel certify that the above sum
(Full name of Agent)

represents freight and passage money earned by this vessel/Airline less our commission, expenses and all
disbursement made by us on account..............................................................................................................
.........................................................................................................................................................................
as per statement given below and this sum is now due to be paid to them, they being the owners/operators of
the vessel/Airline. We further confirm that the regulations prescribed by the Bangladesh Bank have been fully
complied with in collecting the freight and passage money. We further confirm that the amount applied for,
will be remitted out of the funds held to the credit of the said principal without recourse to any loan/overdraft.
1. Balance brought forward
2. Passage and Freight collections:
a) Freight on Export (As per statement in Form shipping I enclosed)
b) Freight on Import ( - do)
c) Passage collections ( - do)
3. Booking of passages and freight on
credit realised during the month as per details enclosed
4. Inward remittances received, if any,
as per Bank encashment certificate enclosed
5. Total (1+2+3+4) above
Less:
6. Outstanding Export/Import/Passage
bookings on credit as per detailed
statement enclosed
7. Disbursements made as per
disbursement statement enclosed
8. Remittances allowed by the AD
9. Total (6+7+8) above
10. Net Remittable/receivable
11. Amount applied for remittance
12. Balance carried over

Signature and Stamp of the


Date : .................................... Shipping Co./Airline/Agent
See Chapter 10 Para 1 (V)(a) APP 5 43

STATEMENT OF FREIGHT/PASSAGE COLLECTION AND DISBURSEMENT IN


BANGLADESH FOR THE MONTH OF .......................................................

SI.No. Particulars (Amount in Taka)

1. Passage and Freight Collection:


(a) Export from Bangladesh as per freight
manifest enclosed

(b) Import into Bangladesh as per freight


manifest enclosed

(c) Passage collection as per passage


statement enclosed

2. Inward remittances received, if any, as per


Bank encashment certificate enclosed

3. Total (1+2 above)

4. Less:
Disbursements made as per disbursement
statement enclosed

5. Total (3 - 4)

6. Amount remittable

7. Amount applied for remittance

Date .................................. Signature and Stamp of the


Airline /Agent.
See Chapter 10 Para 1 (V)(b) APP 5 44

STATEMENT OF PASSAGES SOLD/TICKETS ISSUED BY THE AIRLINES FOR THE MONTH ENDED ...........................
NAME AND ADDRESS OF THE AIRLINE. ...............................

Nationality Particulars of If sanction of


Ticket & whether Destination Route passport/pilgrim pass the Bangldesh
Sl. Name Date of
No. and resident of Name of to of Bank obtained
No. of Remarks
date of Traveller Bangladesh Departure Airline which journey By whom on Form P, quote Amount
issue or travelling Date No. granted the reference of
non-resident the sanction

1 2 3 4 5 6 7 8 9 10 11 12 13 14

I/We declare that the passengers whose particulars are given above actually travelled on due date shown in column No. 5 and the above passages have
been properly recorded in our books.

Date .................................... Signature and Stamp of the Airline


See Chapter 10 Para 1 (v)(c) APP 5 45

STATEMENT OF THE CARGO SOLD BY THE AIRLINES FOR THE MONTH ENDED ……………………………..20
NAME AND ADDRESS OF THE AIRLINES …………………

Sl Airway Bill Consignee Port of Description Gross Discount Actual Other Remarks
Name of the
No No. and destination of the freight (if any) freight charges
Exporter/
date of issue Shipper consignment

1 2 3 4 5 6 7 8 9 10 11

Date : ………………… Signature and stamp of the Airline


See Chapter 10 Para 1 (V)(d) APP 5 46

DISBURSEMENT STATEMENT FOR AIRLINES FOR THE MONTH OF .........................20


Name and address of the Airline .....................................................................................................................

No. Items Amount in Taka


1. Airport Expenses :
(i) Catering
(ii) Handling
(iii) Landing charges
(iv) Repairs and maintenance
(v) Uplift of fuel/oil
(vi) Sundries
2. Agency Commission :
(i) Passage
(ii) Cargo
3. Income Tax
4. Crew Expenses :
(i) Hotel Bill
(ii) Transport
(iii) Daily Allowances
(iv) Sundries
5. Office Expenses :
(i) Salaries, overtime
(ii) Provident Fund
(iii) Taxes
(iv) (a) Office rent
(b) House rent of accommodation, if provided to staff
(v) Telephone and telex
(vi) Printing and Stationery
(vii) Postages and Telegrams
(viii) Conveyance and Company Car
(ix) Advertisement and Publicity
(x) Office equipments
(xi) Electric/Gas consumption charges
(xii) Sundries
6. Refunds :
(i) Passage
(ii) Cargo
7. Entertainment
8. Furniture and Fixture
9. Customs duty etc. on gift articles
I0. Local purchases of gift articles
11. Miscellaneous
Total :

Date .............................. Stamp and Signature of the Airline


See Chapter 10 Para 1 (V)(d) APP 5 47

STATEMENT OF CANCELLATION OR REFUNDS OF PASSAGES FOR THE MONTH OF .....................................20

Name and address of the Airline ...............................................................................................................................................................................................

Particulars of monthly return in


Sl.
Name of Traveller Passport or Pilgrim Pass No. which booking was reported to the Amount refunded Remark
No. Bangladesh Bank

We hereby certify that the above refunds have been given by us as per foreign exchange regulations in force.

Date
Signature and Stamp of the Airline
See Chapter 10 Para 1 (v)(e) APP 5 48

DETAILS OF CREDIT BOOKINGS OF PASSAGE AND FREIGHT REALISED


IN CASH DURING THE MONTH OF ..............................

Name and address of the Airline .......................................................................................................................

Particulars of the Outstanding Credit


Statement in which the bookings made on
credit were reported
Name of the Freight/Passage
Shipper/Importer/ amount raised
Serial number at which Passenger (in Taka)
Items Month the credit item appears in
the outstanding credit
Statement

A. EXPORTS

B. IMPORTS

C. PASSAGES

GRAND TOTAL

Date .................................. Signature and Stamp of the Airline.


See Chapter 10 Para 1 (v)(f) APP 5 49

DETAILS OF OUTSTANDING BOOKINGS OF PASSAGE AND FREIGHT ON CREDIT


FOR THE MONTH OF .................20

Name and address of the Airlines ............................................................................................................................................................................................

Particulars of Passage Statement in


which the credit booking reported Outstanding Freight and
SI. Name of the Shipper/
Importer/Passenger Passage amount
Serial number of the passage/ (in Taka)
Month Freight manifest at which the
credit item appears

A. EXPORTS

B. IMPORTS

C. PASSAGES

GRAND TOTAL

Date ....................................... Signature and Stamp of the Airlines


See Chapter 10 Para 1 (vi)(a) APP 5 50

FORM SHIPPING - I
To be submitted in duplicate
STATEMENT OF FREIGHT/PASSAGE COLLECTIONS IN RESPECT OF
FOREIGN VESSELS AND DISBURSEMENTS IN BANGLADESH FOR THE
QUARTER ENDED .................................................20 .............................................

1. Name of Foreign Ship-owners/Charterer


2.Address
3. Name & address of Shipping Agent

(1) (2) (3) (4) (5) (6) (7) (8) (9)


Collections in Taka during
quarter (both cash and credit)
Name of Port of Inward Inter Outstanding Passage/Freight
SI. Date of Date of as per Import/Export
the remittances agen relating to previous period
No. arrival departure sailing Manifests/Bill of Lading
Vessels as per bank transfer realised in cash during the
Freight certificate (receipts) quarter
Passage
Export Import
A b c

Enclosure: (1) Supporting statements and documents for columns 6, 7, 8, 11 (b, c & d) & 13
(2) A certified true copy of the voyage accounts rendered to the principal.

...............Contd.............P/2
See Chapter 10 Para 1 (vi)(a) Page-2 APP 5 50

(10) (11) (12) (13) (14)


Freight Payable
outside
Deductions/Disbursements as per statements attached Bangladesh as
per Import/Export
manifest advice
Outstanding Net Remarks
Gross Balance
passage/freight Other
Collection Total of Inter payable/
on credit general Remittance
(6+7+8+9) disbursements Agent receivable
relating to the expenses allowed Total
collections (as per Transfer not shown by the (a+b+c+d+e) Export Import
of the current disbursement (paymentt) elsewhere AD
quarter not statement) as per
yet realised as statement
per statement
a b c d e f

SUMMARY:
Balance B/F from previous quarter (+/-)
Add Subtract this quarter (+/-)
C/O to next quarter
Date Stamp and Signature of the Shipping Co./Agent
See Chapter 10 Para 1 (vi)(b) APP 5 51

Form Shipping II
(In Support of column 9 of the statement Form Shipping I)

DETAILS OF CREDIT BOOKINGS OF PASSAGE AND FREIGHT


REALISED IN CASH DURING THE QUARTER ENDED

Particulars of the Outstanding Credit


Statement in which the bookings made Name of the Freight/Passage
on credit were reported Vessel and Amount
Shipowners/ realised
Serial number at which Charterer (in Taka)
the credit item appears
Items Quarter
in the outstanding
credit State ment

A. EXPORTS

B. IMPORTS

C. PASSAGES

Grand Total :

Date :.................................... Stamp and Signature of the


Shipping Company/Agent
See Chapter 10 Para 1 (vi)(c) APP 5 52

Form Shipping III


(In support of column 11 (a) of statement Form Shipping-I)

DETAILS OF OUTSTANDING BOOKINGS OF PASSAGE AND FREIGHT ON CREDIT FOR


THE QUARTER ENDED ............................ RELATING TO THE CURRENT QUARTER ONLY

Name and address of the Shipping Company/Agent : ...............................................................................................................................................................

Port of Date of Port of Name of Outstanding freight and


Bill of Lading discharge/ Ship owners/
Item sailing sailing Name of the vessel passage amount in Taka
Number destination charterer

1 2 3 4 5 6 7 8

A. EXPORTS

B. IMPORTS

C. PASSAGES

Grand Total

Date : ................................
Signature and Stamp of
Shipping Company/Agents
See Chapter 10 Para 1 (vi)(d) APP 5 53

Form Shipping IV.


(In support of column 11 (b) of the statement Form Shipping-I)

BREAKDOWN OF DISBURSEMENTS
S.S./M.V. Nett. Regd. Tons Arrived Sailed

No. Items Amount in Taka


1. Port Charges:
a) Port dues, Pilotage etc.
b) Berth fees, hire of canes etc.
c) Water supply charges
d) Sundries
2. Customs Charges :
a) Light dues
b) Custom penalty
c) Custom overtime
d) Sundries
3. Cargo Handling Costs:
a) Contract rates (Stevedoring)
b) Addl. labour & overtime
c) Lighterage
d) Cartage
e) Cleaning holds
f) Dunnage supplied
g) Tallying
h) Sundries
4. Victualling & Store Supplied*
5. Repairs*
6. Other Vessel Expenses*:
a) Cable and Telexes
b) Postages
c) Stationery
d) Advance to Master
e) Wages paid to Bangladeshi crews
f) Staff overtime & conveyance
g) Medical fees
h) Fumigation
i) Laundry
j) Cost of passages
k) Sundries

.............Contd. .............P/2
See Chapter 10 Para 1 (vi)(d) Page-2 APP 5 53

No. Items Amount in Taka


7. Freight and passage Brokerage :
a) Rebate paid to exporters and importers
b) Freight brokerage
c) Passages brokerage
8. Agency fees & commission:
a) Inward cargo
b) Outward cargo
c) Passage
d) Mails
9. Miscellaneous expenses*:
a) Advertising and Publicity
b) Hotel bills
c) Sundries
10. Income tax.
11. Provisions for other disbursements due
but not yet paid (Please give details)
12. Refund/Cancellation of Passage/
Freight Bookings (Please enclose
detailed statement as prescribed.)

13. Gross Total Expenses


14. Add/Subtract:
Adjustments for provision made under item 11 in
previous period subsequently found to be short or
in excess (Please specify items and the quarterly
statement to which these relate)
15. Net total disbursement for the quarter

*Expenses under those heads involving an amount of Tk. 2500(two thousand five hundred) or over should
be supported by relevant bills/ receipts/vouchers etc.

Signature and Stamp of the


Date : ..................... Shipping Company.
See Chapter 10 Para 1 (vi)(d) APP 5 54

FORM SHIPPING-V
(In support of item 12 of the statement
for breakdown of disbursement Form Shipping-IV)

STATEMENT OF CANCELLATIONS OR REFUNDS OF FREIGHT/PASSAGES


TO BE SUBMITTED BY THE SHIPPING COMPANY

Name and address of the Shipping Company ............................................................................................ for the quarter ended ........................................

Sl Name of Name of Passport or Pilgrim Particulars of the quarterly


return in which booking was reported Amount refunded Remarks
No. Vessel Travellers Pass No.
to the Bangladesh Bank

(1) (2) (3) (4) (5) (6) (7)

We hereby certify that the above refunds have been given by us with the approval of the Bangladesh Bank, where applicable.

Date ............................................. Signature and Stamp of the Shipping Company


See Chapter 10 Para 1 (vi)(e) APP 5 55

(In support of column 6c of the quarterly


statement Form Shipping-I)

STATEMENT OF PASSAGES SOLD/TICKETS ISSUED BY THE SHIPPING


COMPANY FOR THE QUARTER ENDED

Name and address of the Shipping Company

Sl. Ticket No. Name Nationality Date of Name Destination Route Particulars of If sanction of Amount Remarks
No. and date of & whether Departure of to of Passport/Pilgrim the Bangladesh
of issue Traveller resident of Pass Bank obtained on
Ship which Journey
Bangladesh Travelling Date No. By whom Form 'P', quote
or granted reference of
non-resident the sanction

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)

I/We hereby declare that the passengers whose particulars are given above actually travelled on the dates shown in column No.5 and the above passages
have been properly recorded in our books.

Date ........................................ Signature and Stamp of the Shipping Company


See Chapter 10 Para 2A(i) APP 5 56

See Chapter 12 Para 11(i)


FORM "P" (DUMMY)
FOREIGN EXCHANGE REGULATION ACT, 1947
Application to effect booking of passages by sea or air or any other
mode of conveyance on payment in Bangladesh Taka

I/We apply for permission to book the undermentioned passage/s for journey from ..............................................................................................................
to..........................................................................................as per details given below:-

Name of Shipping/ Name of Steamer/ Destination Route Class of passage Cost of passage in Bangladesh Taka
Airlines or other Flight No./Date i.e. first class/
method of of departure tourist class etc. Biman Foreign Total
conveyance (as the case may be) Carrier

1 2 3 4 5 6 7 8

1. (a) Full name, nationality & address of the applicant ..........................................................................................................................................................


(b) Full name of the passenger(s) .......................................................................................................................................................................................

.................Contd. .................P/2
See Chapter 10 Para 2A(i) Page-2 APP 5 56

See Chapter 12 Para 11(i)

2. Naionality of the passenger, passport no. and date of issue ............................................................................................................................................


3. Relationship between applicant and passenger ................................................................................................................................................................
4. Length of residence of passenger in Bangladesh .............................................................................................................................................................
5. Profession or business of passenger while in Bangladesh ...............................................................................................................................................
6. Purpose of visit for which passage is desired to be booked .............................................................................................................................................
7. The date on which the country of destination was visited last .........................................................................................................................................
8. Was permission of the Bangladesh Bank sought for this passage in the past by the passenger or
by the applicant or any person in his behalf? If so, the name of the office of the Bangladesh
Bank at which application was made previously and its outcome may be disclosed ......................................................................................................
9. In the case of *Non-Resident Passengers:
(a) How funds were obtained for support while in Bangladesh?......................................................................................................................................
(b) Particulars of remittances received from abroad ........................................................................................................................................................
10. In case of rebated passage, certificate from airline concerned should be enclosed indicating
grant of rebated passage facility under "IATA" Regulations............................................................................................................................................
11 Consideration for which the rebated passage has been granted ......................................................................................................................................

I declare that the information furnished by me above is correct and in the event of its being not correct,
I hold myself liable for such action as may be deemed fit under the Foreign Exchange Regulation Act, 1947.

Date ............................. Signature of the applicant

*For this purpose, the term "Non-resident" is meant foreign national resident in Bangladesh for less than six months.
See Chapter 10 Para 2A(ii) APP 5 57
'FORM P-2'
See Chapter 12 Para 11(ii)
(To be Submitted in Duplicate)

APPLICATION TO BOOK PASSAGE FOR A DESTINATION


OUTSIDE BANGLADESH AGAINST TICKET ADVICES/
TICKETS PAID FROM ABROAD OR 100% REBATED TICKETS

1. (a) Full name and address of the applicant


(b) Full name/s of the passenger/s

2. (a) Nationality of the passenger/s, Passport


Number/s & date/s of issue
(b) Purpose of visit for which passage is
desired to be booked

3. Full name, address, nationality and occupation


of the person who has made payment for the
ticket outside Bangladesh. In case of 100%
rebated ticket, certificate from the airline
concerned should be enclosed indicating grant
of 100% rebated passage facility under the
IATA Regulations

4. Consideration for which payment has been


made by the person at 3 above or the
consideration for which 100% rebated
passage has been granted by the airline

5. Exact relationship of the applicant with the


payer.

A copy of the P.T.A. or a certificate from the local office of the airlines indicating the amount received in
foreign exchange together with its Taka equivalent received by their office abroad should be attached. The
name of the person favouring whom such payment has been received abroad should be clearly indicated.

(Signature of the Applicant)

............Contd. ..........P/2
See Chapter 10 Para 2A(ii) APP 5 57
'FORM P-2'
See Chapter 12 Para 11(ii) Page-2

(To be Submitted in Duplicate)

(FOR USE IN THE BANGLADESH BANK)

Approval No ................... Date .........................

Mesrs................................................................................ are hereby authorised to book passage for Mr./Ms.

......................................................... for journey from......................to...........against 100% rebated


ticket/*ticket paid from abroad as mentioned above. No payment is to be accepted in Bangladesh Taka.

BANGLADESH BANK
FOREIGN EXCHANGE POLICY DEPTT.

Assistant Director

*Delete not applicable.

Note: i) This form should be completed in duplicate.


ii) The approval of the Bangladesh Bank is valid for three months from the date of approval.
See Chapter 10 Para 2A(iii) APP 5 58

See Chapter 12 Para 11(vi)(a), (viii)

Serial No ......................... Date of Issue .........................

PROFORMA OF ENCASHMENT CERTIFICATE OF


AUTHORISED DEALERS

We certify having encashed Traveller's Cheques/ Drafts/ T.Ts/M.Ts/ Cash foreign exchange/foreign

exchange from Foreign Currency Accounts for total amount of Bangladesh Taka ......................as detailed

below favouring Mr/Ms/M/s ............................................................................................................................

..........................................................................................................................................................................

Currency Amount Account No. Date of Name of the statement/schedule


which has been Encashment and the period in which the
debited* relevant transaction has
been/will be reported

Stamp and Signature of


Authorised Dealer

*This will apply where foreign exchange is encashed by debit to a Foreign Currency Account.
See Chapter 10 Para 2A(iii) APP 5 59

See Chapter 12 Para 11(vi)(b)

Serial No ......................... Date of Issue .........................

CERTIFICATE OF AUTHORISED DEALERS

We certify that the *cheque/pay order No ...................................................... dated ......................................

for Tk. ............................................... (Taka ........................................................................................... only)

has been issued *on/by debit to Convertible Taka Account No. .....................................................................
maintained by us in the name of Mr./Ms./M/s. .................................................................................... as per

Bangladesh Bank's Authority No. ................................................. (State reference No. with date.)

Date .............................. Seal and authorised signature of


Authorised Dealer

*Strike out the words not applicable.


See Chapter 10 Para 2A(iii) APP 5 60

See Chapter 12 Para 11(vii)(viii)

Serial No ......................... Date of Issue .........................

CERTIFICATE OF AUTHORISED DEALERS

We certify that the cheque/pay order No. ............................................................ dated..................................


for Taka ............................Say............................... Taka....................................................... .has been issued
(state amount in words)

by us by debit to Current A/c. No................................................................................ maintained with us by


M/s ...................................................................................................................................................................
(Name of the Shipping Agent/Co.)

Date .............................. Seal and authorised signature of


the Authorised Dealer

CERTIFICATE OF SHIPPING AGENT/COMPANY

It is certified that the amount of Bangladesh Taka stated above has been paid by us towards the cost of air
passage of....................................................................crews for the sector......................................................
(number)

The amount will be reported by us in our Disbursement statement for the month of ..................

Seal and Authorised Signature


Date ........................................
See Chapter 10 Para 2(B) (iv) APP 5 61

PARTICULARS TO BE FURNISHED FOR DETERMINATION OF TAX LIABILITY U/S. 102 OF


THE I.T. ORDINANCE, 1984 IN RESPECT OF SHIPPING BUSINESS OF NON-RESIDENTS

Name of the ship Voyage Date of arrival Probable date Description of Destination of Weight/Measurement
with Owner's/ No. at Bangladesh of departure with Cargo loaded cargo loaded
Charter's name port with name name of port and No. of and
and address of port Passengers passengers
1 2 3 4 5 6 7

Rate of freight/ Total freight/ Exchange Rate Total freight/fare 80% tax liability Remarks
fare charges fare received in terms of Bangladesh on total freight/
Taka fare in Taka plus
surcharges, if any
8 9 10 11 12 13

We solemnly affirm that the particulars furnished above is


true to the best of our knowledge and belief.
(Agents)

1. Signature of the Deputy 2. Signature of Customs Authority 3. Signature of Bangladesh Bank Authority
Commissioner of Taxes Date : Date :
Date : (Name and full address) (Name and full address)
Seal : Seal : Seal :
See Chapter 10 Para 6(ii)(a) APP 5 62

CONSOLIDATED STATEMENT SHOWING INCOME & EXPENDITURE


IN RESPECT OF FOREIGN SHIPPING AGENTS OF BANGLADESH
SHIPPING CORPORATION FOR THE QUARTER ENDED .......................

S1 Name & Credit Freight Amount Total Debit Total Amount transferred Total
No. address of balance collection received from (3+4+5) balance b/f expenditure to BSC's account, (7+8+9) Balance
the foreign from during the BSC or any from if
shipping previous quarter other sources previous
agent quarter quarter Credit Debit

1 2 3 4 5 6 7 8 9 10 11 12

Stamp & Signature of the authorised persons


Date ................................ of the Bangladesh Shipping Corporation
See Chapter 10 Para 6(ii)(b) APP 5 63

CONSOLIDATED STATEMENT SHOWING EARNINGS & EXPENDITURE IN FOREIGN


EXCHANGE BY THE FOREIGN AGENTS OF BANGLADESH SHIPPING CORPORATION
FOR THE QUARTER ENDED ............................................................................................................

Foreign exchange earnings Taka equivalent Foreign exchange expenditure Taka equivalent
1. Credit balance from the last quarter 1. Debit balance from the last quarter
2. Total collection on account of freights 2. Amount repatriated to Bangladesh during the quarter
a) Ship owned by the company (Necessary repatriation certificate to be attached)
b) Ship chartered by the company:
i) Time chartered
ii) Voyage chartered
3. Total collection on account of passage: 3. Amount transferred to BSC's A/C abroad
a) Ship owned by the company
b) Ship chartered by the company
4. Miscellaneous earnings during the quarter: 4. Expenditures incurred abroad during the quarter
(Details as per annexure 'A' attached)
a) Refund on ship stores
b) Refund on final adjustment
c) Charter hire
d) Commission
c) Other receipts
Total (Sl.2 to 4)
5, Funds remitted from Bangladesh
(Quote approval No. & Date
Grand Total Grand Total
Note : Balance held abroad with agents Debit/Credit Tk. ............................................................
(Details of agent-wise position as per Appendix VI/BS
We hereby declare that to the best of our knowledge the above figures are correct and include all the earnings and expenditures of the Company abroad and that no
amount remains unaccounted for.
Place ............................................... Stamp & Signature of the authorised persons
(To be submitted with Annexure A) of the Bangladesh Shipping Corporation
Date ...............................................
See Chapter 10 Para 6(ii)(b) APP 5 63

Annexure -'A'
CONSOLIDATED STATEMENT SHOWING EXPENDITURE IN
FOREIGN EXCHANGE EQUIVALENT BANGLADESH TAKA BY
THE FOREIGN AGENTS OF BANGLADESH SHIPPING
CORPORATION FOR THE QUARTER ENDED ........................20

SI.No. Nature of expenses incurred Amount in Bangladesh Taka


1. Bunker:
a) Water
b) Coal
C) Oil
2. Port Dues
3. Repairs:
a) Emergent Repa irs
b) Dry Docking
4. Ship Stores:
a) Victualling
b) Bond ed
c) Engine
d) Dock
5. Advance to the Master:
a) Bangladesh Nationals
b) Foreign Nationals
6. Agency Commission/Fees:
a) Imports
b) Exports
7. Brokerag e
8. Income Tax
9. Claims (Cargo)
10. Medical Expenses
11. Stevedoring, Tallying, etc.
a) Inward Cargo
b) Outward Cargo
c) Dunn age Expenses
12. Freight Collection/Refund
13. Chart er hire
14. Travelling, Conveyance, etc.
15. Postage, Cables, Telephone, etc .
16. Air Freight

............Contd. ............ P/2............


Page-2
See Chapter 10 Para 6(ii)(b) APP 5 63

Annexure -'A'

17. Boardi ng/L oading


18. Transhipment Charges
19. Printing & Stationery
20. Advertisement
21. Laundry Charges
22. Entertainment Charges
23. Repatriation Expenses
24. Legal Expenses
25. Photo Charges
26. Miscellaneous Charges
Total:
27. Other Charges incurred by the Offices
approved by the Bangladesh Bank
a) Salaries etc. of Branch Office.
b) Payment made to P & I Club
c) Marconi Charges
d) Conference Expenses

Grand Tota l :

Date : ...... ..... ......... ...... .... Signature & Stamp of the authorised person of
the Bangladesh Shipping Corporation
See Chapter 10 Para 6(ii)(c) APP 5 64

CONSOLIDATED STATEMENT SHOWING BALANCE HELD ABROAD WITH BANKS,


MAIN AGENTS AND OTHER CREDIT AGENCIES FOR THE QUARTER ENDED...................

Deposits/Credit Withdrawals/Debit Net Balances


Opening Funds Remittance Opening
credit For expenses Repatriated to Total Debit Credit
receivable from Total debit
balance abroad Bangladesh
from agent Bangladesh balance
1 2 3 4 5 6 7 8 9 10

We hereby certify that the information contained in this statement is true and correct in every respect to the best of our knowledge and belief and the
statement gives complete information of all our foreign currency accounts allowed to be maintained.

Place ..................................................
Signature & Stamp of the authorised person
Date ....................................................
of the Bangladesh Shipping Corporation

Note: The statement should be submitted as at 31st March/30th June /30th September /31st December each year within two months from the close of
the quarter to which it relates.
See Chapter 10 Para 6(iii) APP 5 65

FORM OF STATEMENT OF EARNINGS AND


EXPENDITURE TO BE SUBMITTED BY
BANGLADESH BIMAN

1. NAME AND ADDRESS OF THE AIRLINE ..............................................................................................


2. NAME AND ADDRESS OF THE AGENT ................................................................................................
3. NAME OF CURRENCY .............................................................................................................................
4. FOR THE MONTH OF ....................................................................20

No. RECEIPTS Amount PAYMENTS Amount

1. Balance from the last month 1. Balance from the last month
(receivable) (Remittable)

2. Remittances made during the 2. Amounts received in


month (Bangladesh Bank Bangladesh during the month
Approval No., date and (Bank Certificate to
amount)
be attached)
(i) .....................................................
(ii) ...................................................
(iii) ..................................................
Total :
3. Total collections on account of 3. Expenses incurred abroad
passage freight, excess baggage during month (Statement giving
(Statement showing total breakdown of expenditure to be
passage and freight earnings attached)
separately, to be attached.)

4. Miscellaneous earnings
duringthe month (Refunds, 4. Balance Receivable
other receipts etc.)

5. Balance Remittable

Total : Total :

We hereby declare that to the best of our knowledge the above figures are correct and include all
earnings of the Company abroad and no amounts remain unaccounted for.

Place ........................... Signature and Stamp of the Airline


Company
Date ............................
See Chapter 10 Para 7(a) APP 5 66

QUARTERLY STATEMENT SHOWING EARNINGS AND


EXPENDITURE IN BANGLADESH IN RESPECT OF VESSELS
OWNED BY THE PRIVATE SHIPPING COMPANIES FOR THE
QUARTER ENDED .........................................20

Name and address of the Company .................................................................................................................

A. Earnings Amount B. Expenditure Amount

Credit balance from the last Debit balance fro m the last
quarter quarter
1. Name of vessels: 1. Remittance to foreign agent:
a) ......................................... (Quote BB's approval No. &
b) ......................................... date and also purpose.)
c) .........................................
d) ........................................ 2. Vessel-wise expenditure
2. Date of Sailing .................... (Vessel-wise expenditure
3. Name of Port ....................... shown in the schedule
attached)
4. Total freight collection a) .............................................
......
i) Ship owned by the Co. b) ............................................
.
Export ....................................
. c) ............................................
...
Import ....................................
.
Passage .................................
ii) Ship chartered by the Co. 3. Other payments (state
Import ....................................
. details)
Export ....................................
.
Passage .................................. 4. Head office expen ses
(Exp ort/Import (state details)
manifest/BL / Export
certificates to be attached)
5. Other receipts if any (state
details)

6. Fund received from abroad


(Repatriation Certificate
from the bank to be
attached)

Total : Total :

............Contd. .......... P/2


See Chapter 10 Para 7(a) Page - 2 APP 5 66

Freight payable outside Bangladesh


(state name of port where
the freight will be received)

Net Balance (A-B) Dr/Cr

The figure will not be added to the total figure of earnings.

We certify that the particulars in the above statement are true and correct in every respect to the best of
our knowledge and belief.

Place ................................ Stamp & Signature of the authorised


person of the Company
Date ................................

Note: Supporting Bill/Vouchers in respect of expenditure


for Tk.2,500(Two thousand five hundred) and
above to be submitted.

(To be submitted with Annexure)


See Chapter 10 Para 7(a) Annexure to APP. 5 66

EXPENDITURE SCHEDULE
Name of Shipping Co ...........................................................
Name of Vessel ..................................................................... Voyage No. .................................................
Name of Port ........................................................................ Date of arrival .............................................
Date of Sailing ......................................................................

SI.No. Nature of Expenses Voucher No. Amount

1. Port Charges :
a) Port dues
b) Pilotage etc.
c) Berth fees
d) Water supply charges
e) Hire of cranes
f) Sund ries
2. Custom charges :
a) Light dues
b) Custom penalty
c) Custom overtime
d) Sundries
3. Cargo handling costs:
a) Stevedoring
b) Addl. labour & overtime
c) Lighterage
d) Dunnage supplied
e) Tallying
f) Sundries
4. Victualling & store supplied
5. Repairs
6. Other Vessel expenses:
a) Cable, telex & Postages
b) Stationery
c) Advance to Master
(Quote custom permission No. & date)
d) Wages paid to Bangladesh crews
e) Staff overtime & conveyance
f) Medical fees
g) Fumigation
h) Laundry
i) Cost of passage (Quote approval No. & Date)
j) Bunker supply during....... (month)
(Quote approval No. & date)
k) Sundries

............Contd. ............ P/2............


See Chapter 10 Para 7(a) Annexure to APP. 5 66

Page - 2

7. Freight and passage brokerage:


a) Rebate paid to exporters/importers
b) Freight brokerage

8. Agency fees & commission:


a) Inward cargo
b) Outward cargo
c) Passage
d) Mails
9. Miscellaneous expenses:
a) Advertisement
b) Hotel bills
(Quote approval No. & date)
c) Sundries
10. Income Tax
11. Provisions for other disbursements due but not yet paid
12. Refund/cancellation of passages/
Freight bookings

Total Tk.

Date ........................... Stamp & Signature of the authorised


person of the Shipping Company
See Chapter 10 Para 7(b) APP 5 67

QUARTERLY STATEMENT SHOWING EARNINGS


AND EXPENDITURE OF THE FOREIGN AGENTS
OF BANGLADESH SHIPPING COMPANIES FOR
THE QUARTER ENDED ..........................................20
1. Name of the port
2. Name and address of Agent
3. Name of bank with whom F/C A/C maintained, if any.
4. Total number of vessels called at port during the quarter
5. Name of Vessels called at port
6. Date of sailing
7. Opening balance
a) Due to agent
b) Due to Company

A. Earnings Amount B. Expenditure Amount


i) Freight i) Port dues
(freight manifest ii) Stevedoring
to be attached) iii) Agency fees/commission:
ii) Charter hire a) Export
iii) Passage b) Import
iv) Demurrage iv) Bunker/Water
v) Other receipts v) Victua lling & Provision
(state details) vi) Repairs/Stores
vii) Medical
viii) Income Tax
ix) Other disbursements
(State details)

B. Transfers: B. Transfers:
i) Remittances from Bangladesh i) Remittance to Bangladesh
ii) Remittances from other (Repatriation certificate to
agents (indicating name be enclosed.)
of port and agent). ii) Remittance to other agents
iii) Transfer from Bank A/C (indicating name of
in the same country Port and agent).
iii) Transfer to Bank A/C
maintained abroad (the A/C
No. and the name of the
bank should be stated)

Total earnings (A & B): Total disbursements (A & B):

............Contd. .......... P/2


See Chapter 10 Para 7(b) APP 5 67

Page - 2

Summary Dr Cr

1. Opening balance as at 1st January/1st April/1st


July/1st October.

2. Add/subtract excess of earnings/


disbursement/over disbursements/earnings

3. Closing balance as at 31st March/30th June/ 30th


Sept./31st December

We certify that the above information contained in this statement is true and correct in every respect to
the best of our knowledge and belief and it gives complete information of our earnings and expenditure
and agent's accounts at above port.

Place ................................ Stamp & Signature of the authorised


Date ................................. person of the Shipping Company

Notes:
(1) All earnings and disbursements pertaining to the vessels of the shipping company including those
given on chartered (time voyage) as well as foreign vessels chartered by the Company should be
included in this statement.

(2) A certified copy of the Agent's Statement of A/C. received shall be furnished.

(3) The statement should be submitted together with required documents within 60(sixty) days from the
close of the quarter to which it relates.
See Chapter 10 Para 7(c) APP 5 68

CONSOLIDATED STATEMENT OF EARNINGS,


DISBURSEMENT AND NET AMOUNT REPATRIATED
TO BANGLADESH FOR THE QUARTER
ENDED .........................................................20

Name of the shipping company ......................................................................................................................


Foreign Bangladesh
currency currency
Balance from previous quarter
1 . Gross earnings/receipts
a) Freight collection in foreign ports
b) Freight collection in Bangladesh ports
c) Charter hire receipts
d) Passage fare/other receipts
e) Funds repatriated during the quarter
Total earnings/receipts
2. Gross disbursements/Payments
a) In foreign ports
b) In Bangladesh ports
c) Charter hire
d) Funds remitted to Bangladesh during the quarter
Total disbursements
3. Net earnings/receipts (1 -2)
4. i) Loan repayments from funds held abroad
a) Towards principal amount
b) Towards interest/commitment charges
c) Towards Insurance premium
d) Miscellaneous purposes
ii) Loan repayment through remittance
from Bangladesh
a) Towards principal amount
b) Towards interest/commitment charges
c) Towards Insurance premium
d) Miscellaneous purpose
Total repayments
Closing Balance (3-4)

We certify that the particulars in the above statement are true and correct in every respect to the best of
our knowledge and belief.

Place ................................ Stamp & Signature of


Chairman / Managing Director of
Date ................................. the Shipping Company

N.B. All items are to be reported in equivalent Bangladesh Taka.


See Chapter 10 Para 7(d) APP 5 69

STATEMENT SHOWING DETAILS OF DEBITS & CREDITS TO FOREIGN


CURRENCY A/C NO ..................... MAINTAINED WITH ............................FOR
THE QUARTER ENDED (TRANSCRIPT RECEIVED FROM FOREIGN BANK
TO BE ENCLOSED).

Name of the Shipping Company ...........................................................................................................................................................................................

S1 Date Debit Credit Balance Place where Name of the Beneficiary Purpose Documentary Remarks
No. payment made Vessel evidence

1 2 3 4 5 6 7 8 9 10 11

We hereby certifiy that the information contained in this statement is true and correct in every respect to the best of our knowledge and belief and the
statement gives complete information of all our foreign currency accounts allowed to be maintained.

Place ................................ Signature & Stamp of the authorised persons


of the Shipping Co.
Date

Note: The statement should be submitted as at 31st March/30th June /30th September/31st December each year within two months from the close of
the quarter to which it relates (A photo copy of bank statement containing the transactions should be enclosed.)
See Chapter 10 Para 13,16 APP 5 70

APPLICATION FOR REMITTANCE OF EXPORT CLAIMS

1. Name and address of the exporter ............................................................................


............................................................................
............................................................................

2. TM form for ............................................. Relative EXP Form Nos.


(Amount)
Short weight ............................................................................
Commission ............................................................................
Brokerage ............................................................................
Quality claims ............................................................................
Damage ............................................................................
Arbitration/Control fees ............................................................................

3. Particulars of documents attached in


support of application

(1) ....................................................... 4) ........................................................................

(2) ....................................................... 5) ........................................................................

(3) ....................................................... 6) ........................................................................

We declare that the full proceeds of exports in respect of which the above claims have arisen have
been realised through ...........................................................................................................and that the
(Name of Authorised Dealer)
claims are genuine and no remittance has been made against these claims through any other
source.

Date .......................................
Stamp and Signature of Exporters

(FOR USE BY THE AUTHORISED DEALER)


CERTIFICATE
No. ................................. Date .....................................
.
Certified that the remittance application and supporting documents have been checked and found in
order. Remittance of ....................................................................... may be considered.

Stamp and Signature of Authorised Dealer


See Chapter 10 Para 18 APP 5 71

APPLICATION FOR APPROVING REMITTANCE OF DISCOUNT


ON ACCOUNT OF READYMADE GARMENTS

Part -1

1. Name and address of the exporter: .........................................................................................................

2. Particulars of discount allowed to the same exporter in last 3 years : ....................................................

Export LC/ Amount/ Amount of


Export Discount
Sl. No. contract No Value of Discount Rate of
Bill Value Allowing
& Value Repatriation Allowed Discount
Authority
and Date

3. Export performance of the same exporter in last 3 years:

Export LC/ E xport Bill EXP No Invoice No Realised Amount of


Sl. No. Contract No Discount
No. & Date & Date & Value Value
& Value

Part -2: Required information to be submitted with supporting documents/necessary papers:


i) Reason(s) for claiming discount by foreign buyer(s) and particulars of correspondences with the
buyer(s);
ii) Number, date and value of Back To Back LC(s);
iii) Date of receiving of imported goods, bill no, bill date and bill value;
iv) Amount of import liability and date of payment;
v) No. of master export LC & date, value and date of shipment, etc.;
vi) Quantity of exported Readymade Garments and invoice value;
vii) New sales price if goods are proposed to be sold to a new buyer;
viii) Amount and rate of discount claimed on consignment/bill basis
ix) Name, address and particulars of licence/registration of the Buying House and Freight Forwarder.
See Chapter 10 Para 20 APP 5 72

STATEMENT OF REMITTANCE OF EXPORT CLAIMS


FOR THE MONTH OF ........................................20

NAME OF THE AUTHORISED DEALER .............................................................................................................................................................................

EXP Form Amount of Amount remitted


Name and Name and Export Proceeds Amount realised Date of Nature of Date of (Mention in
address of address of realisation claim remittance foreign
the exporter the buyer No. Date currency
In F.E In Taka In F.E In Taka

1 2 3 4 5 6 7 8 9 10 1 12

Date ............................. Signature & Seal of the Authorised Dealer


See Chapter 10 Para 21, 22 APP 5 73

See Chapter 18 Para 11

SETTLEMENT OF NON LIFE CLAIMS


(Including Facultative Reinsurance Business.)

In support of our application on Form 'TM'(enclosed) for the remittance of .............................. (Amount)
.....................................................................to ................................................we make the following declaration:
of currency) (Country)

1. Policy :
(a) Nature of policy
(b) Amount and currency of policy
(c) Date and place of issue
(d) Insured voyage (for marine policies)
(c) Claim payable at
2. Premia :
(a) Country of collection
(b) Currency of collection
3. (a) Cause of loss
(b) Amount of claim admitted
(c) No. of 'EXP' form
4. (a) If a foreign currency account is
maintained with Bangladesh
Bank's approval, a proforma
statement of the account showing
the latest position should be
submitted.
(b) Date of submission of the last
quarterly statement to the
Bangladesh Bank and the
reference to the covering letter.
(c) Reasons why claim is not being
met from this account
5. Name and address of
(a) the claimant
(b) the claim settling Agent (Where applicable)

6. Whether the applicant Company


has been registered in Bangladesh
under the Insurance Act

7. Name and address in Bangladesh


of the applicant Company

Date ............................. For and on behalf of


Stamp and Signature of Insurance Company.
See Chapter 10 Para 24 APP 5 74

PARTICULARS OF FOREIGN BRANCH OFFICE/SUBSIDIARY COMPANY


OPENED BY A COMPANY/FIRM RESIDENT IN BANGLADESH

1. Name and address of the Principal Company/Firm of Bangladesh:


2. Name and address of Proprietor/Partners/Directors:
3. Nature of business:
4. Amount invested in Bangladesh:
5 Annual turnover and the amount of profit earned during the last financial year
6 Particulars of Income Tax Registration Certificate and amount of Tax paid:
7 Particulars of branch office/Subsidiary Company abroad:
(a) Name & address
(b) Nature of business
(c) Date of opening
(d) Particulars of estimated income and expenditure
8. Justification for opening office abroad:

Signature and name of the authorised Signature and name of the authorised
official of the AD with stamp official of the parent company in
Bangladesh with stamp
See Chapter 10 Para 31(a) APP 5 75

APPLICATION FOR REMITTANCE OF DIVIDENDS TO NON-RESIDENT


SHAREHOLDERS OF ...................................................................
FOR THE YEAR ENDED ..............................................................

Sl Name Address at Reference to No. & value Date of Amount of Net Remarks
No. nationality & which Bangladesh of shares held allotment/transfer Amount of Income Tax/ remittable
present address shares are Bank's authority for (Separate for of shares dividend Super Tax amount of
of the registered change of original each class of due on the dividend
shareholders address to present shares) dividend
address
1 2 3 4 5 6 7 8 9 10

1. Certified that:-
(i) the shares mentioned in column 5 are held by non-resident shareholders and stand registered at their foreign address as given in column 2.
(ii) the above shares are held by the non-resident shareholders mentioned above on the basis of repatriation of dividents as per procedure prescribed by
Bangladesh Bank.
(iii) the amount of dividends applied for remittance is the net amount due to the non-resident shareholders mentioned above after deduction of' all tax
liabilities, if any, payable thereon; and
(iv) * the above dividends for the year have been declared by our Board of Directors at a meeting held on..............out of the net profits of the company
for the year/period ended....... 20....... as disclosed in its relevant audited accounts after making adequate provision for tax and the liabilities and/or
any other undistributed profits as are available for declaration of dividends. The profits made by the Company for the period ended
.............20........... after making adequate provision for tax and other liabilities are considered to be adequate by us and our Auditors, to cover
payment of interim dividends, which have been declared by our Board of Directors on........................................
Contd.........Page-02
See Chapter 10 Para 31(a) APP 5 75

Page-02

We hereby undertake to submit to Bangladesh Bank through our bank the final income tax assessment order as and when obtained
Signature.........................................................
Place .................................................date ......................................
Name ...............................................................
Designation (Director/Secretary)

Certified that the information as furnished above by the Company including those given against items (i) to (iv) paragraph 1 of the above certificate
has been verified by us and found to be Correct.

*Strike out whichever is not applicable AU D I TO R S

Amount of remittance allowed


Date of remittance Rate of Exchange applied for conversion Code Number Remark
Foreign currency Taka equivalent of Taka into foreign currency

Certified that the amounts mentioned above have been remitted strictly in accordance with the foreign exchange regulations in force.

Date :

Seal & Signature Authorised Dealer


See Chapter 10 Para 35 APP 5 76

DECLARATION MADE BY SATELLITE CHANNEL DISTRIBUTOR

TO WHOM IT MAY CONCERN

I/We do hereby declare/undertake that in the event of any excess amount of foreign
exchange remitted to our foreign principal(s) .............................................................,
the amount remitted as such in excess of the actual entitlement will be
repatriated/adjusted to Bangladesh immediately on demand by the Authorised
Dealer Bank/Bangladesh Bank/any other competent authority.

Signature of the Authorised Person:....................................................


Name:..................................................................................................
Designation:........................................................................................
Name and Full Address of the Company ( Distributor): ....................
............................................................................................................
Date of Declaration : ..........................................................................
See Chapter 10 Para 41(b) APP 5 77

FBC-1

LIST OF PAPERS/DOCUMENTS TO BE SUBMITTED BY


LOCAL STOCK BROKERAGE FIRM TO AD

1. Application of the local brokerage firm in the letter head pad addressing to the AD;
2. Agreement with foreign principal(s) specifying description of the services under the
contract, calculation/ratio of sharing of commission etc. between the parties, charges (if any)
to be deducted from the commission earnings, signing and expiry date of the agreement,
termination of contract, renewal of the contract, etc.;
3. Updated Trade Licence, membership licence of the Central Depository, Bangladesh Ltd
(CDBL), membership licence of stock exchange(s), permission of the Bangladesh Securities
and Exchange Commission to work as stock broker;
4. Attested Copy of TIN;
5. Bank Solvency Certificate;
6. Partnership deed (for partnership firms);
7. Certificate of Incorporation, Articles of Association, Memorandum of Association ( for
companies)
8. VAT Registration Certificate (optional).
See Chapter 10 Para 41(d,e) APP 5 78

FBC-2

STATEMENT SHOWING COMMISSION/SERVICE CHARGES PAYABLE TO


FOREIGN STOCK BROKERAGE FIRM (PRINCIPAL) ABROAD AND SETTLED
THEREAGAINST DURING THE MONTH OF ………………….., ………..20

Name of the AD…………………......................………Bank…………….........……………….Branch

Name of Local Brokerage Firm (Agent): ..................................................................................................

Name of Foreign Brokerage Firm(Principal) : .........................................................................................

Distribution of Deductions
commission/service
BO Account No.
Name of Portfolio

Bank Name and

charges earned

commission from earnings


NITA No.
Investors

Net Amount
Sl. No.

Branch

earnings of Principal
Gross

(col 8) Remittable
. (Col 6)

Agent Principal Taxes Others

1 2 3 4 5 6 7 8 9 10 11 = 8-9-10

BDT USD

Total

12. Add: Outstanding as per last statement

13. Net Amount remittable

14. Less: Amount remitted during the month

15. Net outstanding amount


See Chapter 10 Para 41(d,e) APP 5 78

Page-02

We do hereby certify that the above information is correct. We also certify that taxes,
VAT, etc. applicable to commission earnings have been deducted accordingly. We do
hereby undertake that in the event of any excess amount of foreign exchange remitted to
the foreign principal, the amount remitted as such in excess of the actual entitlement, will
be repatriated/adjusted to Bangladesh immediately on demand by the Authorised
Dealer/Bangladesh Bank or any other competent authority.

Signature with date and stamp of the authorised Signature with date and stamp of the
official of the local stock brokerage firm with authorised official of the AD bank
full name and designation. with full name and designation.
Encl. Attested copy of transaction statements of investors

Certificate from the Auditor

Certified that the particulars furnished above truly represent the status of remittable amount to
principal abroad.

Place: ................................................ Signature : .....................................................


Date:................................................... Status : .............................................
Name of the audit firm : .................................
See Chapter 10 Para 41(e) APP 5 79

HALF YEARLY CONSOLIDATED STATEMENT SHOWING


COMMISSION/SERVICE CHARGES PAYABLE TO FOREIGN
STOCK BROKERAGE FIRM (PRINCIPAL ABROAD) AND
SETTLED THEREAGAINST DURING THE PERIOD OF ...........

Name of the AD………………….....………Bank…………………...………….Branch ....................................


Name of Local Brokerage Firm (Agent): ...............................................................................................................
Name of Foreign Brokerage Firm(Principal):..........................................................................................................

Amount Amount
Particulars
in BDT in USD

Share of commission earnings earned during the reporting period


(Net as per summation of FBC-2 of the period)

Add : Outstanding as per last statement of preceding half year

Net amount remittable

Less : Remittance effected during the reporting period (as per FBC-2)

Net outstanding amount (as per last FBC-2)

Signature with date and stamp of the authorised Signature with date and stamp of the
official of the local stock brokerage firm with full authorised official of the AD bank with
name, designation. full name, designation.

Encl.: Copies of Appendix FBC-2, approved TM Forms for the period under report.
See Chapter 11 Para 3 (A) APP 5 80

FOREIGN EXCHANGE REGULATION ACT, 1947


Application for Transfer of Capital/Saving of Foreign
Nationals Retiring Permanently from Bangladesh.

To
..........................................................................................................................................................................................................................................................................................................................................
(Authorised Dealer in Foreign Exchange)

Dear Sirs,
I hereby apply for permission to remit the sum of Tk ......................................to....................................in
(country)
respect of my savings for the period of my stay in Bangladesh from ................... ..to...................... .................

2. I give below the following information in respect of my income and expenses etc. during my stay in
Bangladesh from .......................to .........................during my last 10 years of stay in Bangladesh
from ..............................to..........................................
(i) My total income in Bangladesh and/or funds brought into Bangladesh from abroad through normal
banking channel during the above period were as under:-
(a) Total amount of pay and allowances received during the
period from......................... to............................ Tk. .......................................
(employer's certificate enclosed)
(b) Total amount of Provident Fund, bonus and other gratuitous
payment (not included in sub-para (a) above) received.
(employer's certificate enclosed). Tk. .......................................
(c) Funds brought into Bangladesh from abroad through
normal banking, channel. (Bank's certificate enclosed). Tk. .......................................
TOTAL: Tk. .......................................
(ii) Amount of sale proceeds of my locally purchased and imported household goods as also the sale
proceeds of my investments in Defense Savings Certificate and other securities made for availing of
Income Tax Relief are given below:-

(a) Sale proceeds of locally purchased articles (list enclosed) Tk. .......................................
(b) Sale-proceeds of imported articles (list enclosed). Tk. .......................................
(c) Sale-proceeds of Defense Savings Certificates or other
securities (list enclosed) Tk. .......................................

TOTAL: Tk........................................

............Contd ........ P/2


See Chapter 11 Para 3 (A) APP 5 80
Page-02

(iii) My expenses etc., during my stay in Bangladesh from............to.............were as under : -

(a) Maintenance and other expenses including private travel


expenses etc., incurred in Bangladesh (statement enclosed) Tk. ...............................................
..

(b) Family remittance against family maintenance permits and


leave salary remittances etc., made (details enclosed) Tk. ................................................
..

(c) Any other expenditure/commitment not covered under (a)


& (b) above (statement enclosed) Tk. ................................................
.....

Total Tk.
3. I confirm that I am a citizen of.......................and that I hold Passport No. ......................... ....................
issued by the Government of ..........................The cost of return passage for myself and my family has
been/is being paid by the employer/myself.
4. 1 have been working in Bangladesh:
*(a) in the public sector with ...................................................................................................................
(Name of the employer)
with the permission of Govt. (copy enclosed)
*(b) in the private sector with ................................................................................with the permission of
Ministry of .......................................................................................................................................
*(c) as self employed person in Bangladesh with the permission of the Government (copy enclosed)
5. I hereby declare that I will be permanently retiring from Bangladesh within 6 months i.e. by
............................ and that I have not applied to any other office of the Bangladesh Bank for similar
remittance facility.
6. I declare and undertake that in the event of there being any change in my present plan to leave
Bangladesh permanently, I shall immediately notify yourselves, giving reference to this application. I
shall also arrange immediately to resell the foreign exchange, if any, drawn by me under this
application to an Authorised Dealer in foreign exchange in Bangladesh in compliance with
Sub-section 3 of Section 4 of Foreign exchange Regulation Act, 1947.
7. Necessary supporting documents, as prescribed, are enclosed.
Yours faithfully

Signature..................................................................
Name in full............................................................
Date ........................ Full residential
address in Bangladesh.............................................
Occupation..............................................................

*Strike out which is not applicable.

............Contd ..........P/3
See Chapter 11 Para 3 (A) APP 5 80
Page-03

ENIPLOYER'S CERTIFICATE

Certified that we are the employer of Mr/Ms. ....................................................................


and that we have separately issued to him/her certificate showing the amount of pay and
allowances etc. paid to him/her by us during the period of his/her employment with us
from ........................................................................................................................................
.................................... to .........................................................................................................

Date ............................. Signature of the Employer


with their stamp

AUTHORISED DEALER'S CERTIFICATE

We hereby certify that the statements made above are to the best of our knowledge and
belief correct

Date ............................. Stamp and Signature of the


Authorised Dealer
See Chapter 11 Para 8(c) APP 5 81

FORM OF APPLICATION FOR PRIVATE


REMITTANCE BY FOREIGN NATIONALS TO COUNTRIES ABROAD

To
Dear Sirs,
I hereby request you to allow me to remit the sum of ...........................per month .......................................
out of my monthly income to...........................................................................for a period of twelve months.
2. I declare that: -
*(a) my net salary per month receivable in Bangladesh during the next twelve months after taxation and
other deductions will be Tk. ..................... and in support of this statement, I append a certificate
signed by a responsible official of the Company /Branch/Organisation by whom I am employed in
Bangladesh.
**(b) I am the owner/partner of ......................................................................................................................
(Name of the Company)
and certify that my net income in Bangladesh from this and other sources in Bangladesh, during the
next twelve months after taxation will not be less than Tk ..................... per annum and in support
of the statement I am enclosing for your inspection and return the Income Tax Assessment Order
for the year .......................................................................
(c) I have been continuously residing in Bangladesh since..........................................and to the best of
my knowledge and belief I shall continue to reside in Bangladesh until......................................
.................................................................................................................................................................
(d) I am single/married and the following members of my family who are dependent on my income are
staying, with me in Bangladesh:

Name Relationship Age

I undertake to report to you the particulars of my family members who may join me subsequently.
.

*Please see instruction No. 1 at the bottom of this form.


**Strike out if not applicable.

............Contd ..........P/2
See Chapter 11 Para 8(c) APP 5 81

Page-02

(e) The following members of my family who arc dependent on my income are residing at ..................
.................................................................................................................................................................
(Name of the foreign country)

1. ...............................................................................................................................................................
2. ...............................................................................................................................................................
3. ...............................................................................................................................................................

(f) My monthly financial commitments at home are as under:-


(i) Family maintenance .............................................................
(ii) Payment of insurance premia .............................................................
(in) Educational expenses of children ............................................................
(iv) Legal charges, mortgage payments etc. ............................................................
(v) Loan, Interest etc. ............................................................
(vi) Other miscellaneous commitments (please specify broad details)
(Suitable documentary evidence where possible, should be
produced in support of the above items) .............................................................
(g) After making the remittances applied for the Taka balance out of my monthly income will be
adequate to cover my and my family's living and other expenses in Bangladesh which are broadly
as under:-
(i) House Rent .............................................................
(ii) Family maintenance .............................................................
(iii) Educational expenses ............................................................
(iv) Insurance premia payable in Taka ............................................................
(v) Transport expenses ............................................................
(vi) Servants' salaries .............................................................
(vii) Club (Please specify names of the club) expenses.........................................................................
(viii) Other miscellaneous expenses (Please specify broad details)

3. I confirm that :
(a) I am a citizen of ..................................................................and hold Passport as per details below:
(i) Passport No. ............................................................................................................................
(ii) Issued by the Government of .................................................................................................
.................................................................................................................................................
(iii) Place of birth as per Passport ..................................................................................................
(iv) Residence as per Passport .....................................................................................................
(b) I hold stay permit No. ..................dated ................valid up to........................................................
issued by ................................................................................................for staying in Bangladesh.
My passport is submitted to my bankers for certifying the particulars stated above.

............Contd ..........P/3
See Chapter 11 Para 8(c) APP 5 81
Page-03

(c) All remittances against the permission applied for will be made from savings from my current
Bangladesh Taka income and that the remittances will not involve any payment to any person
directly or indirectly on behalf of any other resident of Bangladesh.
(d) Necessary permission of the Govt. of Bangladesh in regard to my employment in Bangladesh has
been obtained vide their reference No. ............................. Date....................................(copy enclosed).
I further confirm that I have not applied to any other bank branch in Bangladesh for similar remittance
facilities.
I declare that my total salary, allowance etc. in connection with my services rendered in Bangladesh are
being received by me in Bangladesh and that no part of my emoluments is being received by me in
foreign currency in any foreign country.
Yours faithfully

Signature of the Applicant


Date ........................... Name in full...........................................................
Full residential address in Bangladesh..................
...............................................................................
Occupation ............................................................

CERTIFICATE REQUIRED UNDER PARA 2(a)

We.................................................................................................................are employer of
Mr/Ms..............................................................(and a certificate to this effect is enclosed) and certify that
he/she has been employed by us with the prior approval of the Govt. of Bangladesh, vide their letter
No......................................dated.......................... (original enclosed for reference and return). We hereby
further certify that subject to his/her remaining in our employment his net salary during the next twelve
months will be Tk .......................per months as detailed below:

Gross monthly income

(a) Pay Tk. ..............................................................


(b) Allowances Tk. ..............................................................
Less:
(1) Income Tax Tk. ..............................................................
(2) Provident Fund Tk. ..............................................................
(3) Recoveries of advance Tk. ..............................................................
(4) House Rent etc. Tk. ..............................................................
(5) Others including entertainment allowance, Tk. ..............................................................
transport allowance, servant allowance etc. Tk. ..............................................................
Total: Tk. ..............................................................
Net monthly income: Tk. ..............................................................

............Contd ..........P/4
See Chapter 11 Para 8(c) APP 5 81
Page-04

In addition to the above he/she gets the following facilities


(a) ...............................................................................................................................................
(b) ...............................................................................................................................................
(c) ................................................................................................................................................

We further certify that to the best of our knowledge and belief the declarations made by the applicant are
true and no material fact has been distorted or suppressed.
We also undertake to inform you if the applicant ceases to be in our employment in Bangladesh or if any
material change in the circumstances contained in his/her declaration comes to our knowledge.

Date ...................
Name, Designation, Signature and
Stamp of Employer

CERTIFICATE BY THE AUTHORISED DEALER

We hereby certify that the above statements are, to the best of our knowledge, correct
and that we have examined the passport of the applicant and the details given in para
(3)(b) are correct.

Date ................... Signature and Stamp of the


Authorised Dealer

IMPORTANT INSTRUCTIONS

I. In the case of a person who has not been resident in Bangladesh for a period of at least six months, a
certificate from applicant that the applicant has been appointed to their regular staff in Bangladesh
should be produced.
II. The certificate of the employer should be signed by the Manager or a Senior Officer of the Company
etc., stating capacity in which he signs.
III. Applications for such remittance facilities should be made by one member of the family. If there are
more than one earning member one application stating the joint income should be made by any one of
them.
IV. Family means wife and children only.
V. When the applicant is receiving additional facilities like free board/lodging, motor car etc., the
monetised value of such facilities as declared to the income tax authorities should be stated itemwise.

............Contd ..........P/5
See Chapter 11 Para 8(c) APP 5 81
Page-05

(ENDORSEMENT BY THE AUTHORISED DEALER)

Sl Date of Amount Particulars of return in which Stamp and Remarks


No. remittance remitted the transaction reported to signature of
the Bangladesh Bank the AD

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.
See Chapter 11 Para 10 (A) APP 5 82

APPLICATION FOR FOREIGN EXCHANGE FOR STUDIES ABROAD

Manager
(Name of Branch)

(Name of Bank)

(Address)

Dear Sir,

I hereby apply for foreign exchange for my studies abroad, the required details are as under:-

1. Name : ............................................................................................................................

2. Address : ............................................................................................................................

3. Passport No. : ............................................................................................................................

4. Educational qualifications :............................................................................................................................

5. Name and address of the


educational institution where
study will be prosecuted/performed : ............................................................................................................................

6. Name of the course : ............................................................................................................................

7. Duration of the course : ............................................................................................................................

8. Date of commencement of
the course : ............................................................................................................................

9. Annual expenditure
a) Tuition fee : ............................................................................................................................
b) Board, lodging, etc. : ............................................................................................................................
c) Insurance : ............................................................................................................................
d) Travel : ............................................................................................................................
10. Amount to be remitted in advance to : ............................................................................................................................
the educational institute
11. Last date for remittance of advance : ............................................................................................................................
amount

12. Whether the remittable advance is


refundable : ............................................................................................................................

............Contd ..........P/2
See Chapter 11 Para 10 (A) APP 5 82

Page-02

13. Amount sent or to be sent in Blocked account abroad : .........................................................................................


14. Details of foreign exchange
purchased, if any, previously : .........................................................................................

Date of purchase of foreign exchange and amount (If the entire amount has not been utilised under the
relevant head, the unspent balance should be deposited with the application)

In the light of details given above, I may kindly be allowed to purchase foreign exchange amounting to
.......................... towards tuition fee ................................towards board lodging etc.........................towards
travel .........................towards insurance.....................towards blocked account abroad.

Yours faithfully,

(Signature of the Applicant)


Address:

Papers submitted :

(a) Letter issued by the educational institution in


support of admission,

(b) Educational certificates,

(c) Estimate/ invoice issued by the


educational institution,

(d) Declaration by the student,

(e) Valid passport.


See Chapter 11 Para 10 (A) APP 5 82
Page-03
RELEASE OF FOREIGN EXCHANGE FOR STUDIES ABROAD
DISBURSEMENT SCHEDULE (ENDORSEMENT BY THE AD)

Name of the Student : ............................................................................................. Passport No : .......................................................................

Date of Particulars of Course


Sl Amount of FC Released Against (Eqv USD)
Rem. Stamp and Sig Reporting
Tuition Blocked of AD Particulars to BB
1 Class/Course Semester Institution Living Travel Insurance
Fee Account
2

10

Note : ADs shall preserve information in the respective student file using the above format. The above format shall be updated after each
remittance. Photocopy of the above statement shall have to be submitted to Bangladesh Bank with monthly return.
See Chapter 12 Para 2 APP 5 83

APPLICATION FORM FOR FOREIGN EXCHANGE FOR


MEDICAL TREATMENT ABROAD

To
bank
(Name of the AD)
Branch
(Authorised Dealer branch)

1. Name and address of the applicant


2. Nationality, Passport No., date and place of its
issue.
3. Age
4. Period of continuous residence in Bangladesh
5. Nature of disease
6. Particulars of treatment already received
7. Names of Institutions/Doctors who have carried out
the above treatment
8. Treatment contemplated in which country/countries
9. Anticipated length of stay abroad for treatment
10. Estimated cost of the treatment
(i) Estimated expenses for operation.
(ii) Estimated expenses for medicines.
(iii) Estimated expenses for consulting Medical Advice.
(iv) Estimated expenses for boarding and lodging in Hospital/outside.

Total

............Contd ..........P/2
See Chapter 12 Para 2 APP 5 83

Page-02

I hereby certify that the particulars given above are correct. I hereby undertake to submit to you a
detailed account of the expenses incurred by me in connection with any proposed medical treatment and
will submit to them medical/hospital bills/vouchers in support of the statement immediately after my
arrival in Bangladesh from .......................................................

Date .................................
Signature of the Applicant
Name and full address

CERTIFICATE OF THE MEDICAL BOARD/SPECIALIST PHYSICIAN

Date ..................................................

Place of examination .......................

Seal and Signature of the


Medical Board, Govt. of Bangladesh/
Specialist Physician

Important Instructions

1. Applicants are advised to support their applications with all documentary evidence available.
2. Exchange facility for medical treatment will be allowed subject to the conditions that a statement
of expenditure together with supporting vouchers will be submitted to the bank issuing foreign
exchange. Those not producing such a statement will be liable to action under Foreign Exchange
Regulation Act, 1947.
3. Request for further remittances of foreign exchange should be routed through Bangladesh
Embassy/High Commission concerned duly supported by a statement of account and bills for the
initial release of foreign exchange.
See Chapter 12 Para 14(b) APP 5 84

FORM OF APPLICATION FOR ISSUANCE OF PTA

To

................................................................... (Name of Airlines)

................................................................... (Address of Airlines)

................................................................... Airlines

Dear Sir,

Mr/Ms....................................................................................................................................................would
(Name of the guest)

Visit Bangladesh from...........................................to..........................................at the invitation of


this Agency for the purpose of ............................................................................................... His
passage and other expenses as usual would be borne by this Agency. Accordingly, Form 'P', duly
filled in is enclosed herewith.

Please issue a PTA in the name of the above guest per route .......................................................

Yours faithfully,

(Name of the Authorised Officer


of the Applicant Agency with Stamp & Date.)
Telephone No ..................................................
See Chapter 12 Para 19(e) APP 5 85

DECLARATION

I/We .................................................................................................................................................................
(Name and address of the exporter)
holding Registration No. .........................................................................................................................
dated .................................................issued by the .........................................................................................
(Name of the office of CCI & E)
do hereby declare that the packet to be sent by me/us to ................................................................................
..........................................................................................................................................................................
(Name and address of the person to whom the sample is to be sent)
contains bonafide trade samples of .................................................................................................................
(name of item)
of ......................................................................................................................................................................
(state quantity)

I/We further declare that this is a free trade sample without involving any payment in foreign exchange.

`
Date ........................... Authorised Signature and Seal of the Exporter
See Chapter 13 Para 20 APP 5 86

MONTHLY STATEMENT OF NFCD ACCOUNT TRANSACTIONS

Name and address of the authorised dealer bank.............................................................................................

Monthly statement of NFCD transactions for .............................. ...(Month) .................................... (Year).


Currency: Pound Sterling/US Dollar/EURO/Japanese Yen

Sl. No. Deposits Amount

1. Opening Balance ...........................................


a) Bangladesh nationals
b) Foreign nationals, firms, companies etc. ...........................................

2. Amount received from abroad including local deposits to NFCD Accounts, as per FE
circular No. 28 of 1982. (Please attach a list of country-wise figures.) ...........................................

3. Amount received by way of transfer from other FC Accounts ...........................................

4. Amount received from abroad from the foreign nationals, companies/firms and
institutional investors etc. for deposit to their NFCD Accounts as per FE circular No. 44
of 1986 (Please attach a list of country wise figures) ...........................................

5. Interest credited to accounts ...........................................


a) Bangladesh nationals ...........................................
b) Foreign nationals, firms/companies etc. ...........................................

6. Other receipts. ...........................................

TOTAL ...........................................

Sl. No. Withdrawals Amount

1. Transfer abroad to the Account holders (Bangladesh nationals)


2. Transfer to FC Accounts of Bangladesh Wage Earners
3. Transfer abroad to the account holders (Foreign nationals and foreign firms/companies etc.)
4. Miscellaneous payments

5. Closing balance
a) Bangladesh nationals
b) Foreign nationals, firms/companies etc.

TOTAL ...........................................
See Chapter 13 Para 26 APP 5 87

MONTHLY STATEMENT OF RFCD ACCOUNT TRANSACTIONS

Name and address of the authorised dealer bank..................................................................................................

Monthly statement of RFCD transactions for .........................(Month)......................................................(Year)

Currency: Pound Sterling/US Dollar/EURO/Japanese Yen.

Serial No. Deposits Amount

(1) Opening Balance


(2) Deposits during the month under report
(3) Credit on account of interest earned
Total

Serial No. Withdrawals Amount

(1) Transfers abroad under instruction from account holders


(2) Issues in the form of Cash/TC/Draft on account of travel abroad by account holders
(3) Amount encashed to Taka
(4) Used through International Card

Total

Closing balance

Date ...................... Signature and designation of authorised officer


See Chapter 13 Para 31 APP 5 88

STATEMENT OF "FC ACCOUNT FOR IPO"

Name and address of the Authorised Dealer: .................................................................................................

1. Name and address of the Account Holder: .................................................................................................

2. Account No.................................................................................................................................................

Part-A: Particulars of Receipts of foreign currency

Name of the country Name of the Currency Amount received

Part-B: Particulars of foreign currency used against issuance of securities

Name of the country Name of the Currency Amount used

Part-C: Particulars of remittance towards over-subscription of securities

Name of the country Name of the Currency Amount remitted

3. Date of opening of account ........................................................................................................................


4. Date of closure of account ......................................................................................................................../

Date : ............................ Authorised signature and seal

Note : Please, attach encashment certificate in support of Part-B.


See Chapter 7 Para 36 APP 5 89

See Chapter 13 Para 32

STATEMENT OF TRANSACTIONS IN FC ACCOUNTS OPENED FOR DEPOSITING AND UTILISING


ADVANCE PAYMENTS AGAINST ORDERS FOR BUILDING AND EXPORT OF SHIPS

Sl No Export Export Date of Amount received Import Payment against Remarks


FC A/C No
and name of contract/LC value in Expiry in advance LC No, import LCs
the No and FC date,
account holder date value
shipyard

Date Amount Date Amount


1 2 3 4 5 6 7 8 9 10 11

Official Seal : Signature of the authorised official


Name : ........................................................................................
Designation : ..............................................................................
Contact Phone No. ...................................................................
E-mail : .......................................................................................
Date : ..........................................................................................
See Chapter 14 Para 9 APP 5 90

FORM QA 22

(Form of undertaking to be furnished by foreign nationals resident in Bangladesh and companies and
firms whose head offices are outside Bangladesh for maintaining bank account.)

To,
The Manager,
...................................................................
...................................................................
(Name and address of Bank)

Dear Sir,
I/We hereby certify that the credits paid into my/our account with your bank relate normally to my/our
trading business in Bangladesh only and consist of the following:-

(Here state the principal sources from which Taka payments into the account are derived, e.g. payments
received for goods sold, stating general nature of goods).
In consideration of the Bangladesh Bank agreeing to dispense with my/our completing Form A-7 in
respect of every credit to my/our account, other than from non-resident account, I/we undertake that I/We
will not make available to any person or firm in Bangladesh any foreign currency which may be at
my/our disposal, against reimbursement in Taka, without first having obtained the permission of the
Bangladesh Bank (through an Authorised Dealer) by completing Form A-7 in respect of the Taka
payment to my/our account. I/We further agree to complete Form A-7 in respect of any payments into the
account which may not be directly connected with my/our trading activities in Bangladesh, or which
represent remittances received from overseas.
Yours faithfully,

Signature of applicant
Dated...............................
Full name of applicant..............................................................Nationality....................................................
.................................Passport No. ........................... dated ......................issued by.....................................
.............................Occupation........................Address........................................................Date of arrival in
Bangladesh.....................................................................................................................................................
We certify that to the best of our knowledge and belief the information given above is correct.

Dated............................... Stamp and Signature of


Authorised Dealer

Note: This form should be completed in on original and submitted to the Authorised Dealer with whom
the account is desired to he opened for being preserved in the respective account opening file.
See Chapter 14 Para 9 APP 5 91

FORM A-7

(Application to transfer Bangladesh Taka from/to a private Non-Resident Taka Account held in
Bangladesh.)
N.B. (1) This form should be used only when payment is made in Bangladesh Taka to/or from an account
in the name of a person or firm other than a bank resident outside Bangladesh.

(2) This form should be completed in duplicate when the transfer is from one non- resident account
to another.

I/We the undersigned apply for permission to transfer/pay Taka

Say from/to the account of


(in figures) (in words)

(name and address of transferee/transferor or full title of account debited/credited stating

at to/from

the country of residence) (insert name of bank with whom account is kept)

(name and address of transferee or full title of account credited/debited stating the country of residence)

at

(insert name of bank with whom account is kept) for the


purpose stated below:

I/We declare that the statements on this form are true, that the transfer is solely for the purpose specified
above and that this purpose in no way contravenes the provisions of the Foreign Exchange Regulation
Act, 1947.

Name of Applicant

Nationality

Address

Stamp and Signature (s)


of the applicant
Dated
Contd.P/2
See Chapter 14 Para 9 Page-2 APP 5 91

We hereby certify that the statements overleaf are to the best of our knowledge correct and
that we have seen documentary evidence in support thereof, and allowed transfer in terms
of para 13, Chapter 14 of the Guidelines for Foreign Exchange Transactions/apply for
permission of the Bangladesh Bank to effect the transfer.

Date ............................. Signature and stamp of the


Authorised Dealer

Space for use by the Bangladesh Bank

BANGLADESH BANK
Foreign Exchange Policy Department
............................................................

Date ............................. Assistant Director

Note : The approval of the Bangladesh Bank will remain valid for one month from the date of
approval.
See Chapter 14 Para 24 (x) APP 5 92

MONTHLY STATEMENT OF TRANSACTIONS IN NITA


Name of the Bank ...............................................................................................................................
Aggregate position of NITA(s) at the end of Month............................................................................................
Particulars Equivalent USD Equivalent BDT
01. Aggregate opening Balance of all NITA (s) as at 1st ....

02. (a) Aggregate amount credited to NITA(s) during the month with :
(i) Direct Inward Remittance
(ii) Transfer from FC A/C(s) other than as mentioned (iii) below
(iii) Transfer from FC A/C(s) of NRBs working abroad
Total (i)+(ii)+(iii)
(b) Aggregate sales proceeds of shares/securities credited back to
NITA(s) during the month.
Break up of (b)
Purchase price of shares/securities sold and credited back
to NITA(s) during the month
Add: Capital gain earned and credited to NITA(s) during
the month.
(c) Total dividend earned and credited to NITA(s) during the month
(d) Other receipts credited to NITA(s) [ please specify]
Aggregate position of credit entries in all NITA(s) during
the month [ (a)+(b)+(c)+(d)]
03. Total Balance left in FC A/Cs after part transfer/no
transfer to NITA(s) :
(a). FC A/Cs of (ii) of 02 (a) above
(b) FC A/C(s) of (iii) of 02 above
04. Aggregate position of debit entries raised in the NITA(s)
during the month
a) Total purchase of shares/securities in all NITA(s) during
the month
b) Total outward remittances from the NITA(s) during the
month (i+ii+iii below)
Break up of 4(b)
(i) Purchase price of shares/securities
Add: Capital gain earned
Total sales proceeds repatriated abroad
(ii) Repatriation of dividend earned during the month
(iii) Repatriation of NITA(s) credit balance without any
utilisation
Total (i) +(ii) + (iii)
c) Total incidental expenses debited in the NITA(s) during the month
d) Transfer to foreign currency accounts
(i) Transfer to FC A/C(s) other than as mentioned (ii) below
(ii) Transfer to FC A/C(s) of NRBs working abroad
Toatl (i)+(ii)
e) Other debit(s) [please specify]
Aggregate position of debit entries in all NITA(s) during
the month
5. Aggregate closing balance of NITA(s) at the end of the
month ( 1+2-4)
...........Contd to page 2
See Chapter 14 Para 24 (x) APP 5 92

Page-2

Distribution of Portfolio investment by nationality of the investors during the month


[consolidated figure as reported at 2(a) and 3 above of the statement].

Nationality of the Non- 2(a) representing inward (3) Balance left in FC account
Resident Investors remittance and transfer
from FC account(s) in USD in equivalent BDT
equivalent BDT
U.S.A
United Kingdom
France
Other European Countries
Japan
Singapore
Hong Kong
Middle East
Sub-continental (Pl. specify)
Other countries (pl. specify)
See Chapter 15 Para 8 APP 5 93

QUARTERLY STATEMENT OF FOREIGN LOAN APPROVED BY BIDA/BANGLADESH BANK


Name and address of the borrower:…… ……………………………. ..............................................................................................................................................
Authorised dealer bank, branch and address:……. ............................................................................................................................................................................
Specific information & comment on utilisation of the loan:………………………. ........................................................................................................................
Reporting quarter (March/ June/September/December):…………………………………. ..............................................................................................................

Decision of loan Date of Repayment No. of foreign


Lender’s name & Purpose of the Date of
approval Sector sanction by borrowing of the
address loan disbursement period
BIDA/BB borrower
Meeting Date
1 2 3 4 5 6 7 8 9

Total
Total Grace st amount due Total amount Outstanding as
Total Installment Other fees Expiry date Date of 1
borrowed frequency and expenses period repayment since 1st paid since 1st on reference
installment of the loan
amount repayment repayment date date.
date

10 11 12 13 14 15 16 17 18 19

Signature : ....................................................................................... ...... Signature :....................................................................................... ...... .


Name of the authorised representative of the borrowing firm: ............... Name of the authorised official of the AD ............... ..............................
Designation ............................................................................................. Designation : ...........................................................................................
Contact phone no..................................................................................... Contact phone no.: ..................................................................................
E-mail ID: ............................................................................................... E-mail ID :.......................................................................................... ....

Note : For any clarification, FEID, Bangladesh Bank, Head Office, Dhaka may be contacted.
See Chapter 16 Para 3 APP 5 94
FORM-L

FOREIGN EXCHANGE REGULATION ACT, 1947


Application for grant of Taka Loans and Advances

1. Borrower's name and address

2. Borrower's borrowing status i.e. manufacturing,


semi-manufacturing or trading

3. Amount of Taka loan/overdraft applied for

4. Details of security pledged or


guarantee given.

5. Purpose of the loan/overdraft


applied for

6. Period for which loan/overdraft


is required

7. Particulars of existing local


loans/overdrafts:

Sources of borrowing Amount of borrowing Period for which


(To be disclosed limits facility is available
where possible)

Total :
8. i. For companies incorporated in Bangladesh:

(a) i. Paid-up capital As on Percentage

Foreign equity Tk. ........%


Local equity Tk. ........%
Total: Tk.
(b) General and other free
reserves, un-distributed profits
and un-remitted dividends as
disclosed by their last audited
Balance Sheet Tk.
Total: Tk.
(c) Less accumulated loss,
if any, Tk.

(d) Net paid-up capital


[i.e. (a+b)-c] Tk.

Borrowing entitlement ................% of (d) i.e. Tk.


........ Contd.......P/2
See Chapter 16 Para 3 FORM-L APP 5 94

Page-02
ii. For branches of companies incorporated
outside Bangladesh As on

(a) Head Office permanent investment in


Bangladesh Tk.

(b) On remitted profits as disclosed by


their last audited Balance Sheet. Tk.

(c) Less accumulated loss, if any, Tk.

(d) Net Head Office Investment in


Bangladesh i.e. [(a+b)-c] Tk.

9. Manner in which the loan/overdraft applied for is


proposed to be liquidated.

We certify that the above statements are true and that the
taka loan/overdraft facility being granted to us will be
utilised solely for the purpose stated in paragraph 5 above.
Authorised Signature of
the borrower & full address
*Strike out whichever is not applicable.

AUDITORS' CERTIFICATE

Certified that we have verified the information furnished against columns 7 & 8 of the
above application and found them to be correct.

Auditors

(For use by the Authorised Dealer)

I. Amount of loan/overdraft facility allowed Tk.

II. Period for which allowed.

Authorised Dealer
See Chapter 16 Para 4(E) APP 5 95

CONSOLIDATED STATEMENT OF LOCAL BORROWING FACILITY ALLOWED


TO FOREIGN OWNED OR FOREIGN CONTROLLED COMPANIES IN BANGLADESH
BY THROUGH THEIR VARIOUS BRANCHES
(Name of Bank)

IN BANGLADESH DURING THE YEAR ENDED ..........................................................................................................................................................UNDER THE


GENERAL PERMISSION............................................................................................................................................................................................................................

Name of foreign owned Particulars of the Particulars of local loan/ Particulars of other local loan/overdraft limits
or foreign branch of the overdraft limit allowed existing on the date of grant of
controlled Authorised Dealer of loan mentioned in column 3
company extending local loan/ Lender's name and
Amoun Period of Amount
overdraft facility address (where given)
which allowed

1 2 3 4 5 6

Paid-up capital or General reserves & other free Total Losses, Net paid-up capital, reserves Percentage of foreign Remarks
Head Office reserves undistributed profits/ (7+8) if any etc./Head Office permanent equity participation
Permanent un-remitted dividends and profits investment in Bangladesh
Investment in as disclosed by their last audited (9-10)
Bangladesh Balance Sheets

7 8 9 10 11 12 13

Head Office ..............................


Date .........................................
Authorised Dealer (Signature)
See Chapter 17 Para 4(a) APP 5 96

See Chapter 10 Para 2(A)(iii)

(To be printed on letter head of AD)


Ref. No............................................... Date: ......................................................

For use by: …………….............................................................………… (Name of Airline/Shipping company)

CERTIFICATE OF INWARD REMITTANCE AGAINST FOB EXPORTS


A/c: ………………................…….. (Name of licenced freight forwarder)
Licence No.:………………………………………………………

Certified that we have encashed inward remittances of …………… (amount in foreign currency) on
…………… against shipments made on FOB basis for which payment to airlines/shipping companies have
been/will be settled in Taka. Of the inward remittances, equivalent Taka of ………… (amount in foreign
currency) will be acceptable by airlines/shipping companies as per following shipping details:

Corresponding Freight charges


Sl. MAWB/MBL No. Freight charges
HAWB/HBL No. (BDT)
No. with date (Foreign currency)
with date

Signature:………………………………….......................
Name:……………………………………........................
Designation:………………………………......................
PA No.:………………………………….....................….

Instructions:
(a) In case of consolidated remittances, ADs may issue separate certificates for use by respective
airlines/shipping companies.
(b) ADs shall observe proper caution so that aggregate amount of different certificates issued does not
exceed the inward remittances received in consolidation.
(c) Concerned airlines/shipping companies will use the certificates in their usual returns for submission to
Bangladesh Bank.
See Chapter 17 Para 7 APP 5 97

STATEMENT SHOWING THE PARTICULARS OF SHIPMENTS UNDER


OUTBOUND AIR/SEA CARGO DURING THE PERIOD FROM …. TO…..

Name and address of the freight forwarder: .....................................................................................


Licence No. ......................................................................................................................................

1. Particulars of outbound shipments on charges collect basis

Details of Details of Charges paid Charges Service


Name of MAWB/MBL HAWB/HBL . receivable charges/profit Net amount
Sl counterpart Destination EXP Date to airlines/
share payable to receivable
No freight No Shippinglines from overseas overseas freight
freight (FC)
forwarders No Date No Date (Taka)
forwarder (FC) forwarder (FC)
1 2 3 4 5 6 7 8 9 10 11 12 13

Part - A : Statement of earlier months for which receivables remain outstanding

Part - B : Statement of shipments sent during the reporting month

Declaration by Freight Forwarder

We do hereby declare that the statement furnished above is a complete and factually correct statement of
HAWBs/HBLs issued by us during the month of ……………. against export made on FOB basis. We do
undertake to be held responsible for false statement/declaration, if detected, under FER Act, 1947.

Signature: ........................................................................................
Name of designated official of Freight Forwarder: ........................
Designation:.....................................................................................
Date .................................................................................................
2. Particulars of payment repatriated during the reporting month

Name of Details of Details of Amount Encashment


Sl counterpart MAWB/MBL HAWB/HBL Destination EXP Date Date
No freight No
. repatriated Certificate of
forwarders No. Date No
. Date (FC) Ref. No. issue
1 2 3 4 5 6 7 8 9 10 11 12
See Chapter 17 Para 7 APP 5 97

Page-02

CERTIFICATE BY AD BANK

We do hereby certify that during the reporting month we have encashed ………………. (amount in
foreign currency) against inward remittances and issued certificates as per above statement. Necessary
taxes of Tk ......................................... as declared by customers have been deducted/paid.

Signature : ...............................................................................

Name of designated official: ..................................................


Designation: ...........................................................................

Date:.........................................................................................

Instructions:

(a) ADs shall obtain declaration with regards to freight charges and service charges/profit share
separately from their freight forwarder-customers and ensure deduction and payment of applicable
taxes, where applicable.

(b) ADs shall advise their freight forwarders to maintain relevant documents which will be made
available as and when required by Bangladesh Bank/other relevant agencies.

(c) ADs shall maintain customer-wise systematic record of inward remittances and copies of relevant
encashment certificates with relevant documents.
See Chapter 17 Para 7 APP 5 98

STATEMENT SHOWING THE PARTICULARS OF SHIPMENTS UNDER


INBOUND AIR/SEA CARGO DURING THE PERIOD FROM …. TO…..

Name and address of the freight forwarder: ..................................................................................................


License No. .....................................................................................................................................................

1. Particulars of inbound shipments on charges collect basis

Name of Details of Details of Charges received/ Charges Service


LCAF Net amount
Sl counterpart MAWB/MBL HAWB/HBL Country No./ Date receivable from payable to charges/profit share
No freight of overseas receivable from payable
Ref. importers
shipment freight overseas freight (FC)
forwarders No. Date No. Date No. FC Taka
forwarder (FC) forwarder (FC)
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Part - A : Statement of earlier months for which payables remain outstanding

Part - B : Statement of shipments received during the reporting month

Declaration by Freight Forwarder


We do hereby declare that the statement furnished above is a complete and factually correct
statement of HAWBs/HBLs against inward shipment during the month of ….....…………. against
import made on FOB basis.We do undertake to be held responsible for false statement/declaration, if
detected, under FER Act, 1947.
Signature: .............................................
Name of designated official of Freight
Forwarder: ...........................................
Designation: ........................................
Date:.....................................................
2. Particulars of payment made during the reporting month
Name of Details of Details of Country LCAF Charges received Charges paid
Sl counterpart MAWB/MBL HAWB/HBL to overseas Date of Net amount
No of No./ Date from importers
freight No. Date No. Date shipment Ref. No freight remittance payable (FC)
forwarders FC Taka forwarder (FC)
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Certificate by AD bank
We do hereby certify that during the reporting month we have effected remittance ……………….
(amount in foreign currency) against FOB import as per above statement. Necessary taxes of Tk
........... as declared by customers have been deducted/paid.
Signature: ..............................................
Name of designated official: ................
Designation: .........................................
Date:......................................................
See Chapter 17 Para 7 APP 5 98

Page-02

Instructions

(a) ADs shall, before effecting remittances, satisfy themselves with verification of necessary
documents such as invoices from counterpart freight forwarders, import documents, etc. and
ensure deduction/payment of applicable taxes, if applicable.

(b) In case of payment received in Taka/FC from importers against import on FOB basis, ADs
shall be ensured that the payment is supported by certificate as per Appendix 5/13 of this
Guidelines.

(c) ADs shall advise their freight forwarders to maintain relevant documents which will be made
available as and when required by Bangladesh Bank/other relevant agencies.

(d) ADs shall maintain customer-wise systematic record of outward remittances with relevant
documents.
See Chapter 17 Para 7 APP 5 99

STATEMENT SHOWING THE PARTICULARS OF SHIPMENTS


DURING THE PERIOD FROM …. TO…..

Name and address of the freight forwarder: ..............................................................................................


Licence No. ................................................................................................................................................
1. Particulars of outbound shipments on prepaid basis
Name of Details of Details of Charges payable
Sl counterpart MAWB/MBL HAWB/HBL Country of Charges to airlines/ to overseas freight
Destination EXP No. Date
No freight
No. Date No. Date shippinglines (Tk) forwarder (FC)
forwarders
1 2 3 4 5 6 7 8 9 10 11

Total
Add; Opening balance
Amount payable

2. Particulars of inbound shipments on prepaid basis


Name of Details of Details of Charges
Sl counterpart MAWB/MBL HAWB/HBL Country of LCAF No./ Charges to airlines/ receivable from
freight Ref. No. Date shippinglines (FC) overseas freight
No No. Date No. Date shipment
forwarders forwarder (FC)
1 2 3 4 5 6 7 8 9 10 11
Total
Add; Opening balance
Amount receivable

Adjusted receivable/(Payable) [Difference between column 11 of above statements]


Less: Amount repatriated/remitted during the month
Balance receivable/(payable)

Declaration by Freight Forwarder

We do hereby declare that the statement furnished above is a complete and factually correct prepaid
statement of HAWBs/HBLs against outward/inward shipments during the month of ……………. During
the reporting month, we have repatriated/remitted ........... (amount in foreign currency) for which
necessary payment of applicable taxes of Tk........ have been deducted/paid. We do undertake to be held
responsible for false statement/declaration, if detected, under FER Act, 1947.

Signature : .............................................................................
Name of designated official of Freight Forwarder: ..............
Designation:...........................................................................
Date: .....................................................................................
See Chapter 17 Para 7 Page-02 APP 5 99

CERTIFICATE BY AD BANK

We do hereby certify that during the reporting month we have encashed inward remittances/
effected outward remittance ……….....................………. (amount in foreign currency) on ...............
as per above statement. Necessary taxes of Tk ........... as declared by customers have been
deducted/paid.

Signature: .........................................................
Name of designated official: ........................
Designation: ....................................................
Date:...................................................................

Instructions:
(a) Adjustment between receivables and payables may be made subject to deduction/payment of
applicable taxes on eligible receivables and payables and without prejudice to permissions/
approvals, if any, required under any other law.
(b) ADs shall, before effecting remittances, satisfy themselves with verification of necessary
documents such as invoices from counterpart freight forwarders, etc.
(c) ADs shall advise their freight forwarders to maintain relevant documents which will be
made available as and when required by Bangladesh Bank/other relevant agencies.
(d) ADs shall maintain customer-wise systematic record of outward remittances with relevant
documents.
See Chapter 18 Para 6 (d) APP 5 100

DECLARATION TO BE MADE BY POLICY HOLDERS FOR


REMITTANCE OF PREMIA TOWARDS LIFE ASSURANCE
POLICIES EXPRESSED IN FOREIGN CURRENCIES

1. Full name & permanent address in Bangladesh of the


Assured
2. The name and address of the Insurance Co. with which the
policy was taken out
3. The date of taking out of the policy
4. The amount (in foreign currency) for which the policy has
been taken out
5. Type of policy i.e. Life endowment, Educational etc. (Also
state whether with or without profit)
6. The amount of premium intended to be remitted stating
whether it is being paid on monthly, quarterly, half-yearly or
annual basis
7. The period that will be covered by the premium giving the
commencing and ending dates

8. The date of maturity of the policy

9. Name and full address of the Assignee/Nominee in


Bangladesh or abroad

I hereby declare that I am a Bangladeshi domiciled in Bangladesh and that my Life Assurance Policy
No............in respect of which the above particulars are furnished, was taken out on............... (date)
and that the policy is in full force now and not lapsed or become paid up.
I further declare that proposed remittance of premium towards this pertains to the current period and
does not include any past premium payable.
In consideration of the Bangladesh Bank having permitted me to remit premium on my policy
referred to above, I undertake to bring to Bangladesh the proceeds of the policy mentioned above on
its maturity or its surrender value or any claims arising thereunder through an Authorised Dealer in
Bangladesh within one month of my becoming owner thereof.

Date .............................
Signature of the Applicant
See Chapter 18 Para 14(i)(a) APP 5 101

FACULTATIVE/RE-INSURANCE-BUSINESS (PREMIA)
(Not to be used if settlement for Premia and Claims is made on an account basis)

To

Dear Sirs,

In support of our application on Form "TM" (enclosed) for the remittance


of .................................................to ...................................we make the following declaration:-
(Amount of Currency) (Country)

1. (a) Date and place of issue of reinsurance policy


(b) A certified copy of the reinsurance acceptance
note endorsed

2. The currency in which reinsurance is effected

3. Name and address of the beneficiary

4. Whether the applicant Company has been registered


in Bangladesh under the Insurance Act

We undertake to receive payment of any claim under the reinsurance through an Authorised Dealer in
Foreign Exchange.

Name and address in Bangladesh of the applicant Company.

................................................ for and on behalf of ..............................


................................................ ...............................................................

Country of incorporation ...........................

Date ............................. Stamp and Signature of the


Insurance Company
See Chapter 18 Para 14(ii)(d) & 15 APP 5 102

TREATY RE-INSURANCE BUSINESS SETTLEMENT OF ACCOUNT


To

Dear Sirs,
In support of our application on Form 'TM' (enclosed) for the remittance
of ...................................................................................................................................................................to
(amount of currency)
............................................................................................ we make the following declaration:-
(Country)

1. Currency in which re-insurance has been effected ....................................................................................

2. Class of business covered .........................................................................................................................

3. (a) Date of subm ission of last quarterly


statement of the Reinsurance Account
to the Bangladesh Bank giving particulars
of the forwarding letter ..................................................................................................... ................
(b) An upto-date proforma statement of the
account signed by the Manager or an
authorised officer of the company is attached ....................................................................................

4. Name and address of the beneficiary ........................................................................................................

5. Whether the applicant company is registered in


Bangladesh under the Insurance Act .........................................................................................................

We undertake to submit quarterly statements of our above re-insurance account regularly to the
Bangladesh Bank and recover Claim/Profit/Commission through an Authorised Dealer in Foreign
Exchange. It is certified that re-insurance premia is being regularly received through normal banking
channels.

Name and Address in Bangladesh


of the applicant Insurance Company for and on behalf of
.................................................
.................................................

(Stamp and Signature


Country of incorporation .................................. of the insurance company)

Date ...................................
See Chapter 19 Para 19 APP 5 103

MONTHLY STATEMENT OF INTERNATIONAL CARD (IC)


Name of the Bank : ...............................................................................................................................................................................................................
Reporting Month : .............................................................................................. Year : ........................................................................................................

Country Name of Source of FC Total Amount


Sl. TM ID
Code the (Thousand USD up to
No Banks' (If applicable)
Country Customers’ own fund 2 decimals)
fund
Private FC
ERQ FC A/C of of
RFCD Others
A/C EPZs/EZs Bangladesh
Nationals

Signature of the bank official : .......................................................

Name of the bank official : .............................................................

Designation : ..................................................................................

Phone : Land :......................................Cell :..................................

E-mail : ..........................................................................................

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