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See Chapter 5 Para 10
F ORM - C
DECLARATION FOR REMITTANCE RECEIVED FROM FOREIGN
COUNTR Y OF AMOUNT EQUIVALENT TO US S 2 0, 000/ - OR
EQUIVALENT
I/We do hereby declare that I/We have received remittance of _________ ______________________________
( Amount and Currency in figur es and in words)
________________________________ ______________________________ __________________r emitted or
To be remitted by ___ _____________________ __ on account of ___________ ________________________
( Name and address of remitting bank)
_____________ ________________ f or the purpose of _ _ ______________ _ _____________________ __ _
( Name and address of remitter) ( Purpose of remittance )
( Name of Applicant )
Nationality ___________________ _______ _____________
Date ……………………. Address _____________ ____________ ________ ________
Signature and Stamp of the a pplicant
Form C : Inward Remitt ance exceeding US D 2 0, 000 / - (T wenty Thousand) or equivalen t .
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 investme nt 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 f or use by the Bangladesh Bank)
BANGLADESH BANK
Foreign Exchange Policy Department
Assistant Director
Dated.................................
APP. 5 10 See Chapter 5 Para 10