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Annexure K: (One Time) Request letter for the issuance of FIRC

(This updated request letter will replace the Annexure 4 K of e-circular 12314)

Date: 17.03.2021

To,
ICICI Bank Limited,
Ram-Maruti RD, Thane Branch,
Glen Morgan, Ram Maruti Rd,
Veer Savarkar Nagar,
Thane, West - 400602

Dear Sir/ Madam,

Sub: (One time) request for Certificate of Foreign Inward Remittance (FIRC)

Originating Branch Sol ID:

I/We, the undersigned, being duly authorized by Pneucon Valves Pvt ltd. request ICICI Bank to kindly
issue a Foreign Inward Remittance Certificate @ (FIRC) for the remittance received by
________________________________ (Details are already provided in the disposal instruction given by
us):

Name & address of Beneficiary : Pneucon Valves Pvt Ltd, Plot No. A-35, Road No.
10, Wagle Industrial Estate, Thane (W) 400 604
Phone / Mobile number (mandatory for : + 91 9322 030 252
non-customer )
ICICI Bank Account no. where the : 003505000876
remittance amount credited
Name of the Bank & Branch where the : ICICI Bank Ltd, Ram Maruti Road, Thane Branch
remittance amount credited
(For non-account holder beneficiary)
Transaction reference number : RTGS/SCBLH10210000633/LLOYD
INTERNATI/SCBL

Purpose of Remittance : Against Export


Name & address of remitting bank (If : Lloyd International
available)
Date and number of Demand Draft :
received (If applicable)
Amount in foreign currency : Rs. 7,12,500.00
Purpose for which the certificate is :
required by the beneficiary
Please indicate the name of the
authority/bank(s) to which this has to be
produced.

Details of Payment of charges for the Certificate:


* I/We enclose herewith Cheque/draft no. favoring ICICI Bank Limited for
` (Rupees )

* I/We authorize you to debit 003505000876 /- (Rupees


) to our account no .

I/We confirm that the payment has / has not* been received in non-convertible rupees or under any
special trade or payments agreement.

I/We hereby declare that the purpose and transaction details as mentioned above are true to the best
of my knowledge, does not involve and is not designed for the purpose of any contravention or evasion
of the provisions of the FEMA, 1999 or any rule, regulation, notification, direction or order made there
under. I/We agree that I/We shall be responsible and liable for any incorrect detail provided by me/us.

For Pneucon Valves Pvt Ltd.

M.C. Jethwani
Director

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