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See Chapter 5 Para 10
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 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 _______________________________________
Date ……………………. Address _________________________________________
Signature and Stamp of the applicant
Form C: Inward Remittance exceeding USD 10,000/- (Ten Thousand) or equivalent.
Month Country of ordering
Customers
Purpose Amount in (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 us as to the bonafides of the declaration made on this form.
Date ……………….. Signature and Stamp of the
Authorized Dealer
Contd. P/2
APP. 5 10
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 Outward Reference
AD Code Ref. Year AD Code Ref. Year
(Space for use by the Bangladesh Bank)
BANGLADESH BANK
Foreign Exchange Policy Department
Assistant Director
Dated.................................
APP. 5 10 See Chapter 5 Para 10