_Remittance-Form-1(2 sets)

Annexure-B form Government of the People’s Republic of Bangladesh Bangladesh Investment Development Authority (BIDA) Prime Minister’s Office Jiban Bima Tower, 10, Dilkusha C/A, Dhaka. Application for Approval of outward Remittance in connection with Royalty/Technical Know-how fee/Technical Assistance fee/Franchise/Other Technical fee. 1. Name, address and telephone number of the Applicant Industrial Enterprise : 2. BIDA’s Registration No & date (Former BOI Registration) : 3. Upto date Total Investment : Tk. million (US$ ) 4. Name & address of the Foreign Collaborator(s) providing Services/Intellectual Properties : 5. Type of the Agreement (Please tick the appropriate one) : Royalty Technical Know-how Technical Assistance Franchise/Others 6. Effective date of the Agreement : 7. Duration of the Agreement : 8. Schedule of Payment (Please tick the appropriate one) : Monthly Half yearly Yearly One time 9. (a) Total Amount to be paid as per Agreement : Tk. ......................................... million (US$...........................) (b) For which period : 10. Whether the Intellectual Property (Trade Mark/Brand Name/Recipe/other Patent) is registered in Bangladesh(please tick) : Yes No. 11. Cost + Freight (C&F) Value of Imported Machinery(In case of proposed/under implementation project) : Year of import C&F Value(Tk. in million) 12. Previous year’s sales as declared in the Annual Tax Return and amount of income tax paid (In case of industrial unit already in operation) : Sales Year (a) Value of Sales (Tk in mill) (b) Amount of tax paid (Tk) 13. Percentage of the Total Fees in respect of Sl. 11 or 12(a) : 14. Proposed amount of remittances : (Taka in million) Expressed as % of Sl. 11 or 12(a) (a) Royalty : (b) Technical know-how fee : (c) Technical assistance fee : (d) Franchise fee : (e) Other technical fees (Please specify) : Sub Total: : 15. Other Remittance made/to be made during the same Calendar/Fiscal year : Type of fees Amount in million Taka % of SL. 11 or 12(a) Sub Total: Continued Page-2 -2- Annexure-B form 16. Percentage of Total Remittances for the year (14 + 15) in respect of Sl. 11 or 12(a) : 17. Brief Statement of Benefits received /to be received by the Local Company/ Firm under the Agreement : (1) (2) (3) (4) 18. Brief Background of the Foreign Service Provider : 19. Statement of Remittances of such fees for the last 3(three) years : Year of remittance BIDA’s Approval No. & date Amount in million Tk. % Type of fees 20. Statement of Actual Production/Services for the last 3(three) years : Year Items of products/service Qty Sales Value/Revenue 21. Statement of Export Earning (if any) : Yr. of Export Items of Export Qty C&F/CIF value 22. Name & address of the nominated local Bank through which remittance to be effected : Signature of the Managing Director/Managing Partner/Proprietor and Official Seal. Documents to be Enclosed: (1) A copy of Registration letter issued by the Bangladesh Investment Development Authority (BIDA); (Former BOI) (2) A copy of Technology Transfer Agreement(Royalty/Technical Know-how/Technical Assistance/Franchise Agreement) ; (3) Filled-in Prescribed Application Form supplied by BIDA signed by the Managing Director/Managing Partner/Proprietor; (4) Resolution of the Board of Directors of the company/ Partners of the Firm regarding remittance of fees/showing amount, due year of remittance and name & address of the foreign service provider as per Agreement; (5) A copy of Annual Report of the company/Firm comprising Audited Balance Sheet along with the Profit and Loss Accounts (in case of the project in operation) or Bill of Entry/Invoices of the Imported Machinery (in case of under implementation project); (6) Income Tax Return certified/authenticated/attested by Chartered Accountant Firm for the concerned Assessment Year along with Computation Sheet for taxable income for the same period and Tax Clearance Certificate issued by Deputy Commissioner of Taxes of the concerned Tax Circle; (7) A copy of Memorandum & Articles of Association and Certificate of Incorporation of the company (if not submitted earlier); (8) Invoice(s) in support of fees to be remitted; (9) Authenticated Banking documents showing Export Earning (if any); (10) Attested copy of Patent Right/Trade Mark/Brand Name Registration in Bangladesh (if any). (All documents other than Original must be certified by the authorized signatory of the Company/Firm).