o Applicaitr (Remitler) Inlormatlon
N.mo olApp .afl', .........
o
L]
!
tl
o Re.lplenl s (Benercl.ry) lnt hrtlon
I Pa*' lr rhB 3s.c s5 odr.c.oMr
SwlF-I i Clearnq code ........
i--- - --------- l ch46DcblrcM r I - -:l
o lnlormedlary Bank lnrormatlon (Opuona )
@ ".-*,o"ar"1".s. "-,"e, Ror6rci@, e,c..... )
o PurposeotR€mittanc€ {
o Appllcahfs sr9n.luro
J
@ ro.tn,u.nur,.. onry
!u
A Prime Bank
.' \.- " f,.*:tri&q"if ,1.) i : s'{#,".s,.$'t
*"'t-t-l-l-l[II l-'l
Itrtr!
g'5til
Remittance Service Terms
Th€s6 IEms auppldenl lh€ exlsllng le,ms and @ndlllo.s 9eh ng Appll@.i't 5@utrl es.d fo, h6 RedlnaDe Sedie To $e €xla o' aiy
inml$eicy, L\ete lems sholl PIBvai.
1. Rohrfi.ns SeEloe {s) Bs^k shatl ule casonstls eh 6nd lrn h $dldlng $s Rsm\tece seral... (b) unl4..l.ler dale ls specited in t\s
.mri6rion, Sank €hsll seek lo ere.ule lhq rcolltan@ on th6 husines3 day lhal Eaik Eehe. lh. Gmifl6n@ !ppli..lhn, ir P4iv.d pdor lo he
appli@ble cur{il rlme ot Bank\ ledie lodliod olheBile B6nk shsl seek to .xodl. $€ rmludie on lhe h*l tutlneti d6y- Th. rcniltsie nay
rako lmger rhan on. bB!..!! d.y lo 6xdte. (c) Sank ruy lnilrlcl li arlilialo, anolh{ bank, t dq.,ing hdBo, . plyn il, d@dng o, .eileme
syslem or olhsr p6yhhr lnr.medlar, (6a.n r 'D.yn .l inum.dlrlf) ii rho €reqrioi ol th. 6m ai@. Ea.n Bynenl hl.medlory may rcly M
Appli@nlr .emitah.e lnslruclions os I dk€c€d ro lt, (d) 8!nk m.y nol Ex@lo lhs Gditla.e n Apdl€nG .@!nt hds insufidenl lunds, (.1 Ups
Appl,canlt Mltlen rcquGl, Bank 3h5ll us. Ba$.rbl. oflons b eN.1or tlop th. rcmin rc.: h@var, Brnk rh.ll mt b. raponslbl€ ll lho
rc miltaie as e&41e d {0 BMk 6ay a.l on ln dmplelo or lnoi sist6nl ln{ruclioi ! i, B.nt EaronEuy t€li6v$ Ihrl Tl Bi 6 mpl.l. or .la dly 5uc}
lnfom.lld sllh@i cr6!,lng lo Appll6.l (q) Bank or r p.ymqil lntemed ary @y n.ke r"y Gquied d@ncy @^ve6i.i. Ao.Bttdlid o..rhEr
.crum ot l!nd! nay liv6lv. 3 r.866 turen.y.oi@*lon, 8nd lpplioil .hell b.4 rny,.l.l.d losr, ch!4.s, @ers and .rpon$s ol any tind
rcsull ia rrcm suih cunsic, @NoBlon.
3. Lca.randRosuril.rycohpllanco:S..illsarfare.andpaymedrlnla,medh,csaresbl4rrorheta*ordd6req!ensaidgutdenes(€a.ha
1e9u r'ioi")o,v6ridc qov6m66dal qussi-eov.mme^la ands€rrresuraloryaurho.ilios(e6cnri'aulhoiy)sndst$rorhorcsp€.rvdooi.ie.and
!@eduEs (3ach a po cy") adoplod by Ba,N k atr ales and paym.ii id.mcdizfies rellins to, wilhour inirdin anli-oney laundeiigi
@r1re..1enr'sirian.ligrr.cudiy.dpomar.,Lzde,li[aid.t .6non ns;6!nord.6 inyesligalioisiLar.si
tans.clon,3ucw End moillorii9rsnd 6ponn9 rcq!nome^ts. rnsorins 10 @mllyijlh 6ucJr reo,lai]6ns ond ooidos Aank. {ssffisres 0nd/or
palmcd hremicd!do3 hdy (3) 3uspend. rcio.lor brocr $€ ren nance:(b)r€rEtn, d6dEl rmpouid a^d/o.luF ov€.1oan aur,\oily. Apptiails
lundsh respe.ror lho.6nirl6ie ncrud^glrcmAopi.3ilsaMunk (.lreponore€htance irs dsla h add thoso or app @nr ro ona or nore
aulhodte! 3nd (d)kkc or/ode!,rrcm {akiig snyolh!r adon appietrr 6halrbE$lhdrtsk dra.ydelsysnd toss* reral ng (o aiyaid a adors or
a.nk, b ,rfrares aid parm.ir inL,m.drros may nor b6 psmined b dls.tos6 ntomalo^ rclatj^q ro scltois rakei in
nspedo, 'd!!lr ff3 o. rh6 rrolhles inrhsd'arety o, sl.iy rhd
4. Forcs Majou,6r Ba.k hav 6uspcnd o,le ni de {ho oio.uron ol rhs Gmilanc. as a r.su roisn/ rorcc m4eu,o ova^t, ndudiig w rrou m ration,
mo.idns,e.lcro^on$eavdabrv,6nrcdibi(vc,ediorlm.sre6sirvorstrvor€icyid)iairmeordorau ofa;yp,y-ed^lemedar/r(e)
i{|lailurcold6fuUtoloseMcsprovr!edolyendorIosai|:(9)'
o,(h)anyorherev3nrb.yDnd s,ik3 b8oB5o @1ror appisd $drbe lhedsk
orony de ay a.d rosscs m dlrho10 r,orco n4cye *trl
5 iroddio.ois.106ur!:Appl@.r6^se^GtoBaikdiscldsngroirs!rfirsres,Loihendrherrcsp..ryesefric.p,ovd6rhsure6aidp.or6ssonal
,ies aid aulhortlc!, and.s mqured by rcguaron rhe nromalon lhatApp c6nllumshed ^
th! appr6lroi
5 Lih l.r on ol Llrblltv: hdcmhrv G)aank shalrnol b. Laue Io Apgrienr lor sny toss [].1App 6ilmay i.uro, orh.tuisc su a,, howave, anr n9
o,drsolb.dand*halsvorlhotesath3ssotlhel:blyn@niecjo.kjrhBank!p,ovis.nofjheRenian.
bv kaud. s,oss n.9 ige^6 orr rT! n s.oiducr on Baik s pan. Bonl sharnolbe robrc rorsdytndrecror6is.qu.nlk o5sor oss oiprcfl6erhor
o' iol rhey wd.e ro,sserbLo, {b) 3a ssArpri@frfraysunerorhdr ^6 Frncnt nlem.di.rv (.)Apprlanl ihdcmn llos aafr and lrs afi iares oi dema^d a_osiin.ny andal iossesrhai 6ank andlo, irs ar r$ mvhntr
rheRanndn.6s.Me,exegilolho.he wirhrespac oarnkor..y
1!)r^rpi*irtus50reclodsENonlhesppr@rioiSanksrrdrseeilo6recl.nvreesor€rpens.sdueorpaysbleby&prieirrnrho,en,rlar6
:noud 8mk mav chsioq appr ca^r addirionar rees o, erponsos ro, 6nc. dion ,equ6ts, Elum.d rcniu;e" uia oir,* **prb- r,"or "g tuir ! ,lhiranm and oli.r r6ss :hdr be rn s@d!^co wrrh h q.odard t6d s.
1b)nAppisnlMs.orecledouRo^rheappri6ron Bsnk ruv cnaroc
^pprica a^addil0nsr,emirlancereuro-,0,r"*puyuur" "ip+,-r remedtuy.Ba.ksha !..i lo hsru.r a I payment n16,med aies ro arc d deduding any rees o, *r_*. r,", *" "., "^.i ,.*" ., u.r $ir^orbe rssp.N !lB rherd s psyhenr nlen.d dryhas nade a deducron
nhmrdtarei:8ai\mryenleridot.erndnromalonsMrngdrangemontswilhdpayhenror.ftedaryi
renry" parha nEmsdiill/ .pori
rcm rflirrare mcons pimo srrk Lim red oraiy oi ts suusrdarlss iicrud n9 beLhmd o,ri*s md ba;ch6
h.rtbe grv.r^od by t,re t.w. orlhdludsddE" orAgpl eds *@hr r.r rhe rehida,.e. Tho 0ad:es slbmi( ro r/rc
noi+rdusivclu'lsd cr oi or lhe oins otrheJudsddioi piose odvemns sw oppres
2. R.m n,n.r Oh sit on.: Apprisil dg.€!s aid auhodzas Bant lo dobiru?r.on|he rer r.n€ shouirard anyamounrpaya5o ^ @inediotrvnh
0,e Rcm Mr. Sefricelron atry or Appr @trrs !@unls wjlh aani
{
@Prime Bank
Sec Chspter 5 Para2
(Namc & addfess of the Baok to whioh applicotion iE made)
l/Wo wish to purchlse/remit
' L Fo, Tror.l Purpos.s'
I/Wedestetovavcllc....................................forrhepuryoscor..........
TheJouh.y w,l. l-e tr rderrak.n b) ... ...
(a) Reason for Dayment....
FORM 'TM'
Travcl lrd Mlscellaneous
Purposc! (otho thsD import)
APPLICAITON FOR PERMTSSTON UNDER FOREIGN EXCIIANCE
REGULATION ACT, 1947 TO PURCHASE FORTICN EXCHANGE
FOR THE PURPOSE SPECIFIED BELOW
APP.5 9
(Amouir in ti8nrcs and words srarin8 dtrrn.y)
Llr'c hcrcby dcclare tha! the sratenlcnh m.de by me/us on this forft are (tue and lhrl I/we a.v. nol
already obtained .xchangojpo! hsv.I/we made a.y othcraFp icarion lor rhe t)!rpos.
(Name ol rhe Air/ShippiDg Company)
Mylolr Passpon Nos, datc & placc ofissuc src give bclow:
G)
(b)
G)
'8. For "!scellaneo t purposes oth.r thah ttuwl and i,tryon:
{bl N.tme & addrecs of berefi( Eo
(() Cod) .' ofbencfi,,aa
,
Siqhdte, Ndhl e dnd.4.1l ress
al the ,4PPli.aht
Conrd..P/2
TM II)
tiDc"d"
S€c Chapter 5 Prls 2
1a) wc hev. istucd Norcs & Coi.s . . ... .. .. " ,'' "" T/C
Pegs2
Coltifi.atc of spp.oiol of thc Bangladesn Bank (if requilcd)
wAlid for j0 0hitty) days fro$ lhe datc ofaPProvall
Seat & Signau.e oflhe BaiBlsdesh Badk Ofiicial
(Cc.lilicdt€ by Au(horh.d De!l.r)
uc
APP. 5 9
Decldrarlon tobc !i8ned h] ih' tra!cller/r'hltlcr
rri llirl.*c'e(oen.(.lh!linrhec'cilofanynni'Prc!cnurronorsuppr'ssionoial' rn'reIia 1j''
_' I;* "hallb" r,ab.c ro lron und(r rhc ForciEn Lrchaltc RcEuldriol Acr' 1947
(b) Thar thc lbr€is. cxcharge rclcascd 1o mc/os shall be used lbr cxpenses incurcd bv mcsns in
ro, c 8_ cot"rD/courrtr' tJ,
'(ii rny/our livint.nd t.avelling .tPcnses lor busincss purPoses'
.(ii) hy/our ctuourc cxPenscs fot lrov€lablold
''(iii) rny/ou llvin! eip.hscs and mcdical rrHrmcni'
r., lAc.tu,rres\var.rhare\.hsnSehsLcdrome/rsunderLhrt'omto'lnve nurPoses mdv ollv
-
"" .r."" -, U, ...* "n
_v/ou; Jep'ture irom Bansrad'sh tnd mav nor b' scnr olt bv tosr or
through rhe nrediud of aDv orhet pe6onor bv anv othe! mcans
\d''l'nar'flr. lratct ha( ro! occo fden'ker' lor r\e pJTo\' mentioned abo\c orf mylmPc
_. i.,.,S" .*n, ,g. .ensrnr.e 'n mvbur pos(c(son or Jt m)/our drsoo"l or*hrch@ul! orbc
ut;tls_eO r* rle p.rposc for rvhich n wai Ennlcd, willbc sol'l bv me/urq lo anAulhorised O€al$ in
lorc,8n ex0hangc in Bangl0d.sh immediarclv on mv/ourrcrurn rcBangladcsh'
'(c) lAvc declarc rhar rhe pavncrl nlcntioned 68ainn 'b'6bove is d!' ro bc made bv rne/Lrs for qhich
' 'do.uncnrary cvidercc is cnclosca and assumc full rcsponsibilirv for complving witl' tht
o -rh,",,. "i ,r," f".r*, ex change Rc8l]Lar iotr Acl, I 94? and rules ordc6 aid dire'tives issucd
It,c'.!ndcr /
Tohl..: . .. . .... ... as pn Bansladcsh Bank apProtal dsred '
endoEed rh. amou.r rclcused ir rhi truvcllers pssPo'1ali( cxumining lhc ricr'l corcling ftc p s8''
r{b) wc have.ffcored reninai$ of. . . .. .. . . .. ...
(s'a'c'houfl)
inrcrnr\ofl,ara .. ... Cbaprcr.. ... .. . oi C FET/Bangtddcsb Bank s
approv,lNo. .. . ...... drt.d .... . .. . .'bv' " " 'on" ,'"" " "" "(TTMT/Draft)
Conrd "P/l
Prra f Se€ ChrPter5
Prg.-J
l/ *c hereby conit iavilS r'ceiledfic 'xchanBc
ssucdio me/us a! abovc'
" Stritc out itcms no! apPli'abl€
APP. 5 9
Sithntrrc an'| Sta'l.I '(li)'
Ar^at8 l Dell'r
s ign at u/. (t) of t h e,@t i'd r 4 t
t
I
Cage to be complcred t'v 'Authorised Deiler itrdlcoring
Bsnsladesh BaIk.
Codc No. as ler Code lisl ciiculaled bv rhc
Antount in forcigr curLency
I