The original file is kept in the office. This is the text saved from it.
1 page
100%
Page 1 of 2
FORM-C
DECLARATION FOR REMITTANCE RECEIVED FROM FOREIGN
COUNTRY OF AMOUNT EXCEEDING USD 20,000 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 an d address of remitter) (purpose of remittance)
(Name of Applicant)
Nationality:
Date: …………………………………… Address:
Signature and stamp of the applicant
Form-C: Inward Remittance exceeding USD 20,000 (Twenty thousand) or equivalent.
Month Country of ordering
customer 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
✓
Page 2 of 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
(Space for use by the Bangladesh Bank)
BANGLADESH BANK
Foreign Exchange Policy Department
Date ............................ Assistant Director
Outward Reference
AD Code Ref. Year