/
G) Aeplicaif lRdmire, lnlomarion
N3n,. olADlr cant . .. ........ . .. You, Rererence No.
o R.clpi.nrs (EDn.rci3./) rnrormaiion
o
o
L sr,^i d6 .h qs bomc.vci
L- orF a, bG mddss* d,
:r 8EN.ai bG dry(sad4
co!^iry'
o lnr.rhedrary Bank tnrormanon {oprion.t)
swrFT/cedrrq codc ..
a
o Purpose or Remlltanc. i
o
o
nn TN l-t t-l
J 1l" a-rf
A Prime Bank
*"'I-ILI ltl fll
rTr E_t Ltt Il
Remittance Service Terms
Thile lL,ns supplroc lhe ornrhg lc,ms aDd @idirois govehhg app @nrs 3u,nl ussd ro,lhe RerLieie s.Ri@
1a)36ni 5h.!rus. reasor3be are a4d skil npr.vdins ueF.mllan@ s.M... (b) Uile$ s larcr carc : se.o'iad'f, b'z
ipLr.aidn.Bink!hglse.rloeig
rpd.a5 e.ul{flrnc sr Ernr'5:ery cnbuslncssdsv nercmi(anct'iav
c crmut. k)Firk msy isrrucli1a
.,(.acra p.'meir inlemediry') ii th. .rN.Jr o^ or lh. enrrlanc Ea.n ,ar?n.^r ldenn.d iry m3, relv rn
rfpicr srcmirric!,ntudionrs.ird.edcdrci ld)Ea mayidt6 ou h35idsdr.errtuids lc)lpcn
A!p,t, i 5 wirh rqu.:r, 8sn! s
1r) 8rd mir i oi .@mnreE o,l onatybe.!es rrral ren omprcle o' dJrY 5r.11
lsir (q) Ba^k o, : p,yneil om ncy coiv.6iod.
^
.ai* rtr oro,cx'€,
d e Rd^rrd,0. Se,vice Lom 3dy or^ppr6d s a6ui5 wlh 8ani.
reeu d m) or 4do6 eowmmmb ror/ suLhodrs (.a.r 3 i .auhoiLn
/c.edyes (.3.h a poricr') srop
@uLr,.r d ! D Jr,..rtr!i8.cJrly
rn seeiiill10 @rpr wrh su.n regual ons 6nd po .tcs
,,!/,roi i rn,od118 may(d)suspeid relocroJ blo.r lh3 remrlaica: (b)resr,n, ddd rnpound and/o.lun o!d roan a,lholry. Arpr€r|s
tunisii rer,recr.rrhd rehnl8i.o. r 1.)repn us fmMnce
irhud 4i,td 1d)bkc drobsr ro
ro dte.tos6 i.rormaroi r.latnq lo.dions rake^ in
4 Fdc Mrsftr Br't f.y 6uspcfd o, rem narrrhs dscur on or rha Giiuaico.s, Esulroiany rdre nateure eveir noudmq eilhdu mriri.n:
1,).'r,n!e i3nyrusul31so,hr anyrcsuatcn (b)acr, ordo. or rerues o,6ny 3ulhojily {ctreslddro^ or
nrprnj nq 4rldioi ol u. rvd ab biryo,siycurercy,(d)ralureord., nor3nypalnsr dunedlr/ k)
;(,) hiur ,, dertur or o seNr.! p.o\idei or vsidor lo Bdir: (q) any t&ruro tn lho r.rsm..on oi. c,
horemran.dnnEdDniorlh)snyolh.reve bcroidsts,kscasoiab
crsnydd:y rrd ossca tr d iolo o rorcc najoto *mr
5 h,ori :on D;.ldsurd: Alp c Irisles,Loilsa.dlheitrp.dive5c
n.s and ruriodr 0. ard a5 Equncd uy rcqualon. rhc nromaro. thar A
Lry, G)a r sisr mrb. pro.i raytdcJr d,otheeire nircr holorsadsis
lbasso,Lhel.!liry ncoi.ccltonyirhs:iktp,ovis6io,rrcRo,i[ai!
byk ud.grc$ncoirei6orhrlulhrcondu.ron8.i{span.as rh!
s Dl rh.ypse romemblo. (i)Bari sh.fl.o ie rcsp.nsb e ror.fy o
l.)App c6ir icennircs srfr rnd i
(r)rr^opi:ilhassur..lcdsENonjhespprs!or.sairrrdt5eciio@.cranyr.esoreI,ensesdueorpal.rrreuy&dcflkmrh.reiril,i@
lces oid olhEr el.cp|]ona h:^dl.q
3l bo in 6cccd:i.e r0r trs scndard to (.
(b) ,l\pr., rrasseiecrcdouRo^rheap,ierons3nNmaydaEcAppli.airanadslomrsmirlan.er@ro@rcrre6piysbeLoalp:rnht
ilorh.dh.r.s: eank m.y d e,li
TheG i.-d!ftriry .payme jira,idE{. -poricr. md lsou dm.h
rfim arfriare n'cra Pnnlo Bank L m icud^q rh.rhesd oi4.os and brnclrcs
iuri3d.lion oj^opr6^rs acrunr ro
d5 o, rhe iudsd don *nosa goye,iig hw 6pp es
fi.u-LL
,l
@Prime Bank
FORM 'TM'
Travel otrd Mh.ellaneoxs
Purposes (oth.r thr! import)
(Nrlrc & &ldr*s ofth,i A!,rt ro rvl)ich rppli.arnrn is madc)
I !\'c \..h to Fu -'r.e 'eniit...
. A Fa, iruu,lP"t?o:es:
I /we dcsnc to lEvel t. ........,.,., .,.,, ,.,,.. ,....,..... ...... foi thc purposc oI
Sce Chrptcr 5 P^t^ 2
T}I ID
Tnejoum€y rvill be DDdcrt.kcn by..........
(a) Rcieon for payDcnt.-..
APP.5 9
(Ahourr ii ilgn,.s .nd Nords sr.(rn8 (xrii.i.y)
I/u'. hcrchy dccl,rc tlat t)re sialenrenls madc I-y flie/us oD rhs tom .re rmc and rh3r L'we h ,..o1
al,c.dy obrained exch,nBc Ior ldve lA!e rhadc any orhcQprlication for thE r,urposc
(Namc of lhe Air/Slrippiog Conpanr)
M)/Our Prsspon Nos, drte & !lacc ofisslc irc giacn Lclow:-
G)
(b)
(c)
rB- Fot,tsce dheokt pllrposcs othct thah trawl and nnpatl
(b) Nane & address olboneficia.y
(c) Country of bencfl ciar-v.............
4r.
S)gha|urc, Nan1. a CAdLtcs
a./ the ,applt.dht
Contd.P/2
APPLICATION FOR PERMISSTON UNDER FOREIGN trXCHANCE
REGULATION ACT, T947 TO PURCIIASE FOREIGN EXCHANGE
FOR THE PI]'RPOSE SPECTFIED BELOW
'l'fr'""-'
Sec ChaPter 5 Par^2
Prg!2 APP. 5 9
/1r, lff'*
Decl'rrtton to !c siSncd bt tht tr'!cllcr/rcmincr
L, Ird,rr..c.ot"..c' Jrinrree c{rtar,n r t re'''"'"1 ' '"rpl"l" :1.:' "v 'n'rr''jJ' r'
Ixc \rl rclho' loarl.onurd(:rhcfor'iLrL\'hr1tcl( E d1o1^(r r_"'
(b) Thal lhc lo..is. uch'i8e rclcascn to mclus sh3ll b' used tbr cxpenses incurcd bv nresns in
lorcign coun1ry/counlr)'s ior
'(i),ny/our livins aid l.avclllnB erpcrscs forL'usi'css Duooscs
r(ii) my/gur .nroric .xpcn s.s ror ndvel0brood'
'rLi'/ n)'oLr 'rv,nU('!c- cs'-d -cdi'rlrr'!' ''al
o\var. tna! crchanEc isslcd lo mdus !'der lnis fom for lrnv.l PurDoscs oY o'lY
mcrus on my/o,r dcpanrre from Bangl^dcsh lid may not b. scir our bY Posr or
nnn ofaDy orhc. pc^on or bv snv otlr'r mctis
(d) lhar if rhe ralel hds nor bccn trndenlkst aor 'he PurPos e mcntioncd abo!., or if any unstcir
remaining i, nrr/our Poss'$io' o, which @uld ot bc
urilised lor lhc PDOosc foi Nhich it sar Eranlcd, ei an Artho,ised oealc' irl
forci8n cxchangc in Ba^Eiodesh immcdiarelYon mY/our
"(") )AVc doclarc llai lhc pavd.nl nlcDrio'ed aSsinsl 'b'lbove is duc lo bc m.de bv rne/us for which
Cocrhcntaty c!idcnce is cncl!tcd and assufrc ibiIry for cohPlYinS wilh rhc
p.ovisions ;f rhc !o,ci8n Exchalge RcgrLario I Acr'
a.n,f-r"rco'-DD'.',. oIr\- 8.n8 "'('r Brnl ( I Icqt'n'd)'
lvil d lr r0 rr' :ryr dr's tor' lhc C"rc o' oDp'o'ol'
(C..lifi ;rte bY au$orlstd D"ler)
tnr.n,\o ,.ri........,.....ChAptcr..............,.,ofCFET/,Bddghd.shBant\
.pp',vrlNo.. ... .... .d"kd "" " ""' bv'''""""
10 \t havc issucd Norcs & Coins ' " ,' " T/C "" ' ---- VC""""" -- ""'
Tool.:. . ....... as per Bid8hdcsh Ilank dPproval d&r" - ---':']- - '_ " ,_ ..i11
cndo6€dlh.amounlrckNediirhelruvcIlelspssPo.taft.rcxlmii;nc$etickdco!din8$epass8e,
r(b) vt havc eficcrcd remirl.n* oi . . - "" '-'
(srat6md )
,,....(TT,4VT,D6i)
Conld..?/l
\
r.r.1'
S€e Chapter 5
ti1
APP. 5 9
<,"-"t,t. onJ lt r.t ' r t'r'
'''" Ar'hnt \, I D'ol r
Si8n.ture(i oI rh' "tPrti'a n l!)
CrEc ro tc d,nlPl.rcd try Alrhoriscd Dcalcr i'di'tr(irt C'dc No ds lcr Codc I'st cltculal.rl ht ll'c
Anx,urt in for.ign c"nmcy
, Slrikc our ilems not aPPlicable
t
I
I
I/ *c hcaby c.rtliv havilrs rccci!ed rhc exchin8c issu'd ro mc/us as abov€'
dk'€'^