App 05
App 05
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 : Signature :
* 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
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
ENCASHMENT CERTIFICATE
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
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
Exchange
Part -4: Particulars of Transactions with Authorised Dealer Bank Through FC Account
Blank TC Blank TC
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
Part B : Particulars of Nostro Accounts Opened During the Half Year Under Report
Part C : Particulars of Nostro Accounts Closed During the Half Year Under Report
Part E : Particulars of Vostro Accounts Opened During the Half Year Under Report
Part F : Particulars of Vostro Accounts Closed During the Half Year Under Report
Part G : Particulars of Bank A/Cs of Own Exchange Houses Abraod as on End of Period
Part H : Particulars of Bank A/C of Own Exchange Houses Abraod Opened During the Half Year Under Report
Part I : Particulars of Bank A/C of Own Exchange Houses Abraod Closed During the Half Year Under Report
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.
APPROPRIATENESS MEMO
Date : ................................................................................................................................
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?
Date: .........................................................................
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 -
TM ID Inward Reference
AD Code Ref. Year FORM 'TM' AD Code Ref. Year
Travel and Miscellaneous
Purposes (other than import)
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
remitted or
to be remitted by on account of
(name and address of remitting bank)
(Name of Applicant)
Nationality
Date ..................... Address
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.
BANGLADESH BANK
Foreign Exchange Policy Department
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.
FORM-C(ICT)
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 : ..............................................................................................................................................................
Coded by : .............................................................
Checked by : .........................................................
Signature and stamp of Authorised Dealer:
Purpose of remittance : ......................................... Date:
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 )
†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:
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.)
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
(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 )
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:
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.)
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
(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 )
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.)
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
CERTIFICATE
name with amount) Eqv. BDT.................. (Amount) as indicated in the Bill of Lading/ Airway
.........................................................................................................................imported by Messrs
...........................................................................from..............................................................per s.s
Monitoring Copy of the relative L.C. Authorisation Form No........................ dated the
Designation : ...................................................................................................
P.A No. : ...................................................................................................
Contact Phone No. : ...................................................................................................
Date : .............................................
See Chapter 7 Para 17 APP. 5 14
7. Condition for payment of Import Bill: DP/DA for .........................days from presentation/acceptance
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).
Address
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
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………………………..……...
(Bangladesh Bank approval will remain valid for 30 days from the date of approval)
Coded by .......................................................
Checked by ....................................................
Date ............................................................... Signature and Stamp of the AD
(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 Bank)
No.
SL No.
AD Name of Amount Name of Amount Name of Amount Amount Importer (if any)
overdue
Name
No. Code
loan/grant etc.)
Year
Importer IRC
reported to
Exchange (cash/
Explana tion if any
address
Source of Foreign
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 Bank)
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
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
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:
Form- BC
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:
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
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)
Page-01
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
..............................................................................................................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
MONTHLY STATEMENT OF RETENTION AND USE OF FOREIGN EXCHANGE RECEIVED FROM DIRECT/DEEMED
EXPORT FOR PAYMENT OF IMPORT LIABILITIES FOR THE MONTH OF ..............
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
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
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
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
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
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
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
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
EXPORT REGISTER
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
A. Statement of export:
1 2 3 4 5 6
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.
Monthly maturity position of the total outstanding Against current Against overdue
Export b ills bills bills
1st month following the month under report
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
Note: Please fill in only columns 1,2, 3, 5, 9, 10 and 13 in respect of deletions which should be grouped together.
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
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
PART : IV : SUMMARY
Outstanding as on Tk
(end of previous month)
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
....................Contd. ....................P/4
See Chapter 8 Para 15(b) APP 5 35
(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
Name and address of the Exporter ............................... ERC No. ................ PRC Issued For........................PRC No...........................Date...................................
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. :...................................................................................................
Name and address of the Exporter .......................... ERC No.................... PRC Issued For...........................PRC No..........................Date.......................
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. :...................................................................................................
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:
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):
(b) Country..............................................................................................................................................
(c) Beneficiary........................................................................................................................................
(d) Address..............................................................................................................................................
(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
This is to certify that we have received following inward remittance for purchase of shares in
.............................................................................................................................................. (company) :
Signature: .............................................................................
Name of authorised official: ................................................
Designation: .........................................................................
Seal: ......................................................................................
Date: .....................................................................................
See Chapter 9 Para 12 APP 5 41
(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. ..............................................................................................................................
(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) .......................................................................................................
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
4. Less:
Disbursements made as per disbursement
statement enclosed
5. Total (3 - 4)
6. Amount remittable
STATEMENT OF PASSAGES SOLD/TICKETS ISSUED BY THE AIRLINES FOR THE MONTH ENDED ...........................
NAME AND ADDRESS OF THE AIRLINE. ...............................
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.
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
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
A. EXPORTS
B. IMPORTS
C. PASSAGES
GRAND TOTAL
A. EXPORTS
B. IMPORTS
C. PASSAGES
GRAND TOTAL
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 .............................................
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
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)
A. EXPORTS
B. IMPORTS
C. PASSAGES
Grand Total :
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
BREAKDOWN OF DISBURSEMENTS
S.S./M.V. Nett. Regd. Tons Arrived Sailed
.............Contd. .............P/2
See Chapter 10 Para 1 (vi)(d) Page-2 APP 5 53
*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.
FORM SHIPPING-V
(In support of item 12 of the statement
for breakdown of disbursement Form Shipping-IV)
Name and address of the Shipping Company ............................................................................................ for the quarter ended ........................................
We hereby certify that the above refunds have been given by us with the approval of the Bangladesh Bank, where applicable.
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.
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
.................Contd. .................P/2
See Chapter 10 Para 2A(i) Page-2 APP 5 56
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.
*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)
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.
............Contd. ..........P/2
See Chapter 10 Para 2A(ii) APP 5 57
'FORM P-2'
See Chapter 12 Para 11(ii) Page-2
BANGLADESH BANK
FOREIGN EXCHANGE POLICY DEPTT.
Assistant Director
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
..........................................................................................................................................................................
*This will apply where foreign exchange is encashed by debit to a Foreign Currency Account.
See Chapter 10 Para 2A(iii) APP 5 59
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.)
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 ..................
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
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
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
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
Annexure -'A'
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
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
1. Balance from the last month 1. Balance from the last month
(receivable) (Remittable)
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.
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)
Total : Total :
We certify that the particulars in the above statement are true and correct in every respect to the best of
our knowledge and belief.
EXPENDITURE SCHEDULE
Name of Shipping Co ...........................................................
Name of Vessel ..................................................................... Voyage No. .................................................
Name of Port ........................................................................ Date of arrival .............................................
Date of Sailing ......................................................................
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
Page - 2
Total Tk.
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)
Page - 2
Summary Dr Cr
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.
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
We certify that the particulars in the above statement are true and correct in every respect to the best of
our knowledge and belief.
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.
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
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
Part -1
1 2 3 4 5 6 7 8 9 10 1 12
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)
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
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.
Certified that the amounts mentioned above have been remitted strictly in accordance with the foreign exchange regulations in force.
Date :
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.
FBC-1
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
Distribution of Deductions
commission/service
BO Account No.
Name of Portfolio
charges earned
Net Amount
Sl. No.
Branch
earnings of Principal
Gross
(col 8) Remittable
. (Col 6)
1 2 3 4 5 6 7 8 9 10 11 = 8-9-10
BDT USD
Total
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
Certified that the particulars furnished above truly represent the status of remittable amount to
principal abroad.
Amount Amount
Particulars
in BDT in USD
Less : Remittance effected during the reporting period (as per 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
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........................................
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..............................................................
............Contd ..........P/3
See Chapter 11 Para 3 (A) APP 5 80
Page-03
ENIPLOYER'S CERTIFICATE
We hereby certify that the statements made above are to the best of our knowledge and
belief correct
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:
I undertake to report to you the particulars of my family members who may join me subsequently.
.
............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. ...............................................................................................................................................................
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
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:
............Contd ..........P/4
See Chapter 11 Para 8(c) APP 5 81
Page-04
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
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.
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
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
See Chapter 11 Para 10 (A) APP 5 82
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 : ............................................................................................................................
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
............Contd ..........P/2
See Chapter 11 Para 10 (A) APP 5 82
Page-02
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,
Papers submitted :
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
To
bank
(Name of the AD)
Branch
(Authorised Dealer branch)
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
Date ..................................................
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
To
................................................................... Airlines
Dear Sir,
Mr/Ms....................................................................................................................................................would
(Name of the guest)
Please issue a PTA in the name of the above guest per route .......................................................
Yours faithfully,
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
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.) ...........................................
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) ...........................................
TOTAL ...........................................
5. Closing balance
a) Bangladesh nationals
b) Foreign nationals, firms/companies etc.
TOTAL ...........................................
See Chapter 13 Para 26 APP 5 87
Total
Closing balance
2. Account No.................................................................................................................................................
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.
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.
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
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
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.
BANGLADESH BANK
Foreign Exchange Policy Department
............................................................
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
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
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
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
Note : For any clarification, FEID, Bangladesh Bank, Head Office, Dhaka may be contacted.
See Chapter 16 Para 3 APP 5 94
FORM-L
Total :
8. i. For companies incorporated in Bangladesh:
Page-02
ii. For branches of companies incorporated
outside Bangladesh As on
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
Authorised Dealer
See Chapter 16 Para 4(E) APP 5 95
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
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:
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
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
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 : ...............................................................................
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
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
Total
Add; Opening balance
Amount payable
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
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,
We undertake to receive payment of any claim under the reinsurance through an Authorised Dealer in
Foreign Exchange.
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)
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.
Date ...................................
See Chapter 19 Para 19 APP 5 103
Designation : ..................................................................................
E-mail : ..........................................................................................