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    App. V 118 Form - R

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    Shaheer Adil
    This document is a declaration form required by the Foreign Exchange Regulation Act of 1947 for receiving foreign exchange amounts over $10,000 for purposes other than export or family maintenance. The form collects information about the immediate remitter, including their name, address, country of residence, and status. It also requests the name and country of the ultimate controlling parent if different from the immediate remitter. The recipient must provide their name, principal business, national tax number, address, and signature. The authorized dealer will also sign and stamp the completed form.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    App. V 118 Form - R

    Uploaded by

    Shaheer Adil
    151 views3 pages
    This document is a declaration form required by the Foreign Exchange Regulation Act of 1947 for receiving foreign exchange amounts over $10,000 for purposes other than export or family maintenance. The form collects information about the immediate remitter, including their name, address, country of residence, and status. It also requests the name and country of the ultimate controlling parent if different from the immediate remitter. The recipient must provide their name, principal business, national tax number, address, and signature. The authorized dealer will also sign and stamp the completed form.

    Original Description:

    C5-AnnexA C5-AnnexA

    Original Title

    C5-AnnexA

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    This document is a declaration form required by the Foreign Exchange Regulation Act of 1947 for receiving foreign exchange amounts over $10,000 for purposes other than export or family maintenance. The form collects information about the immediate remitter, including their name, address, country of residence, and status. It also requests the name and country of the ultimate controlling parent if different from the immediate remitter. The recipient must provide their name, principal business, national tax number, address, and signature. The authorized dealer will also sign and stamp the completed form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    151 views3 pages

    App. V 118 Form - R

    Uploaded by

    Shaheer Adil
    This document is a declaration form required by the Foreign Exchange Regulation Act of 1947 for receiving foreign exchange amounts over $10,000 for purposes other than export or family maintenance. The form collects information about the immediate remitter, including their name, address, country of residence, and status. It also requests the name and country of the ultimate controlling parent if different from the immediate remitter. The recipient must provide their name, principal business, national tax number, address, and signature. The authorized dealer will also sign and stamp the completed form.

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    © All Rights Reserved
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    APP.

    V 118

    FORM – R

    Foreign Exchange Regulation Act, 1947

    DECLARATION IN RESPECT OF RECEIPTS ABOVE $ 10,000/- FOR PURPOSE


    OTHER THAN EXPORT & FAMILY MAINTENANCE

    I/We advise having received foreign Exchange from:


    (a) Name & Address of the Immediate Remitter: __________________________________
    (b) Residence Country of Immediate Remitter: __________________________________
    (c) Status of Immediate Remitter:
    (Ultimate Controlling Parent (UCP)/ Head office, Branch,
    Agent, Subsidiary, Associate, Individual etc.) __________________________________
    (d) Name of Ultimate Controlling Parent (UCP),
    if different from (a): __________________________________
    (e) Residence Country of
    Ultimate Controlling Parent (UCP): __________________________________
    for the purpose viz.: _________________________________________________________
    purpose code (insert the relevant code from the Code Guide):

    amounting to _______________________________________________________________
    (Name of currency and amount in figures and words)

    Name of the Beneficiary: _________________________________


    Principal Business: _________________________________
    National Tax Number: _________________________________
    Address of the Beneficiary: _________________________________

    (Signature of the Beneficiary or his banker) (Stamp & Signature of Authorized Dealer)
    APP. V 107

    SCHEDULE J/O-3

    Period ……………………………………………………………..
    Authorized Dealer ………………………………………………….
    Currency ………………………………………………………….

    Code Number
    From NTN of the Country of the Status of the Country of Ultimate
    Serial R/IRV Amount Purpose Beneficiary Immediate Immediate Controlling
    No. Number . Remitter Remitter* Parent/Head office**
    1 2 3 4 5 6 7 8

    Total

    * UCP or Head office or ultimate remitter = 1, Branch = 2, Subsidiary = 3, Associate = 4, Agent/bank = 5,


    Individual = 6
    ** Insert the code of country of the Ultimate Controlling Parent (UCP)/Head office if the immediate remitter in
    Col 7 is an agent, subsidiary, branch, associate of the UCP .

    Coded by: …………………...


    Checked by: …………………..
    Stamp & Signature of Authorized Dealer
     

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