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Form C

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See Chapter 5 Para 10 FORM -C APP.

5 10

DECLARATION FOR REMITTANCE RECEIVED FROM FOREIGN


COUNTRY OF AMOUNT EXCEEDING USD 10,000 OR EQUIVALENT

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


(Amount and Currency in figures and in words)

________________________________________________________________________________________ remitted or
To be remitted by ______________________________________________________________________ on account of
(name and address of remitting bank)

________________________________________ for the purpose of __________________________________________


(name and address of remitter) (purpose of remittance)

______________________________________
(Name of Applicant)

Nationality _______________________________

Address __________________________________

__________________________________________
Dated ………………………. Signature and Stamp of
the applicant

Form-C: Inward Remittance exceeding USD 10,000 (Ten thousand) of equeivalent.

Country of ordering Amount in


Month Purpose
Customers (state currency)

Coded by _________________________

Checked by _______________________

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

________________________________
Dated ………………………. Signature and Stamp of
Authorized Dealer

Issued by The Hongkong and Shanghai Banking Corporation Limited in Bangladesh [November 2020] Page 1 of 2
See Chapter 5 Para 10 APP. 5 10

(Space for use by the Bangladesh Bank)

BANGLADESH BANK
Foreign Exchange Policy Department

Assistant Director
Date ……………………….

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 of Business, the reasons why the investment is required must be
clearly indicated. In the case of the remittance of the sale proceeds of securities the name of the true
owner of the securities must be given and also the approximate date of purchase.

Inward ID Outward Reference


AD Code Ref. Year AD Code Ref. Year

Issued by The Hongkong and Shanghai Banking Corporation Limited in Bangladesh [November 2020] Page 2 of 2

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