Form-C (2023)

FORM-C DECLARATION FOR REMITTANCE RECEIVED FROM FOREIGN COUNTRY OF AMOUNT EXCEEDING TO USD 10,000/- OR EQUIVALENT I/We do hereby declare that I/We have received a remittance of USD 25,000 (Twenty-Five Thousand USD Only) (Amount and Currency in figures and in words) (US Dollar Only) remitted or to be remitted by MUGH Bank Ltd. (Name) and Nishikufo konohana- KU Osaka-shi, Osaka, Japan (address of remitting bank) on account of Nisshin Transportation Co. LTD. for the purpose of Office Management Cost (Name and address of remitter) (Purpose of remittance) Hiroki Miwa (Name of Applicant) Nationality: JAPANESE Date: 05/12/2023 Address: K2 Tower (9 th Floor) Joy Bangla Road, Tongi Gazipur-1700 √ Signature and Stamp of the applicant Form C: Inward Remittance exceeding USD 25,000/- (Twenty-Five Thousand USD) or equivalent. Coded by Checked by Purpose of remittance Office Management Cost. 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 Bonafede of the declaration made on this form. Date: 05/12/2023 Signature and Stamp of the Authorized Dealer Contd. P/2 Para 10 See Chapter 5 10 APP. 5 Month Country of ordering Customers Purpose Amount in (State Currency) Page-2 Note: Full details must be given for all remittances which are of capital nature. In the case of amounts for investment in Bangladesh in shares or business, the reasons why the investment is required must be clearly indicated. In the case of the remittance of the sale proceeds of securities the name of the true owner of the securities must be given and also the approximate date of purchase. Inward ID AD Code Ref. Year Outward Reference AD Code Ref. Year Para 10 See Chapter 5 10 APP. 5 (Space for use by the Bangladesh Bank) BANGLADESH BANK Foreign Exchange Policy Department Assistant Director Dated.................................