Sec Chaptcr S Para2
TM ID
APP.5 9
APPLTCA ION FOR PERMISSION UNDER FORETGN EXCHANCE
REGULATION ACT, I947 TO PURCHASE FOREICN EXCHANGE
FOR T}IE PURPOSE SPECTFIED SELOW
-a ,, ' i rt,
tM- ..nal1 o/Lr:..; t.:.19. ..... ...
S+r:r* ..Sas /s...|in-+ { qd..,...
My/Oxr Passpon Nos, d.te & placc ofissoc arc siven bcloe:,
h)
rb)
G)
+8. For nlkcellokeots ptrposes othet than. ttutel dn.t i1hpoft:
1u 1 Rc:son ror p,1menr..-.19.qi,icA.. .c..),l..Mitlo/;ltrll-..[ *.
rb, Nrme & ;dd,ess or be,,r,,;",y llu^nt'a.t.l74ildtd)..U.,.UA
Dhc
(N.rc & addre* oftrc Brnk to wl,ich lpplic^rlon is melc)
lrwd wilh to purchrse/renrit - .. . .. . t r lhc u (irJ
(^mou!t in lirnics and wor.ls srriinB {r,trdx.y)
,'Wc hcrcby dcclarc lhat the starenlents m.dc ly me/us on rhis fom lre rtue an( thrl Use Iravc iol
a rcadr obtained cxchanse!o! llave l^ve hadc any orhc! .pplicarjon for rhe prrpos..
'^ For Trard P,ryo:e,r:
I NVc deske to travcl tc ,..... ,..,,,,, ,, ,.,,.. ,. . .,.-..'.,, . fo. rhc plrposc oI
Tbe joumey lvill be undertak.n by
[Namc ofIh. Air/ShipFins Conpary)
(c) Courrry ofbcneficiary .![Ea";!.art sL
...j.0.6d..11!t t-o'
.-s.
trllvlp:kqa t0 Lto
t4IL€-l -W,r^
!;ignature, Na"te and Atl.lt?\s
o/ the,lPpli..ht
Conld...P/2
FORM 'TM'
Trlvel ud Miscella$eous
Purpos€s (other thsn import)
^r, ilI R"r F.,.";l
S€o Chapter 5 Para 2
.(r) \!cl,avcssucdNoics&Coiis....... . " ' ,'" 'TlC
P!gc2
uc
as pcr Da grrdc l ba-l dpPro'-l dr'd,, ,,,,,,,,,,
APP, 5 9
Decl!rntlon to bc sientd b) rh' tra!cller/r'mi(ler
,ir 1tirl.*c,e!oc''.rrJri'.iree "' olan/1'''c,eYnerronor'unl''''onorevrar':"f'd
'' .',. *,i o.' ul". ro dtr.on J' d. r'( ror':E. t \'r Jrbc P("" rrr n
^'r' )9"
(b) Thar rhc lbrcisi erch^i8c alcascn 1o mc/us !h'll be lscd lbr cipenses i'cuircd bv nreans In
r.,ci8n courtry/cou.r.ics lor
'(i),nylou.li!i.8 iid rravellin8 cxPc ses fo' busi'css l)u'poscs'
'(ii) hy/or, crourc cxp.nscs ior trev'! ahrosd'
''(iii) rn,/our livins crpcns.s and 'ncdic!l IrBlDCnr'
l.v. mn.Dr'li.rh'rc1(h'-Le'''rorometr'ude'$r'romlorr'-!clnury"sc-itrvorlv
"'r",.:;.;:.;;;;.',."nn'"u,u.r.tu'cr,onBrrPrJd''haidn0)horb'nnrourbvoo'ror
(hrough rhe n)clllun ofanv orhcr p'6on ot bv {'v orhc'hci's'
if rh. t.vel has iot b.co udcnakqr tor rhe puaos€ ,ention€d obovc. or if any unsPenr
.r.bdse remaini.g i6 mr/ou posscsioD or ot dYlour disposal oi which @uld itor bc
ro. rho puryosc for vhi0h n *is eranrcd, ro an,^rlhorised Dealcr in
fo,cig cxcha.Sc in BatBl.desh inn'diirclv on ny/our reru.D lo Ba!Sladesh'
'(0) lAVe doclrc rhli the Pavncnr nrcnlio'td a80inn
Co.!dcntary cvidcnce is cncloscd and assum
'b sbov€ h duc ro be madc bv rne/us for which
iry for cohtlYins wirh rhc
p.ovis;ons ;f thc lorcisn Eich3nge Rc8\rL'rion A'1, 194, [.d rules, ordcts and
L ut ac.nc ol Looro,r. o, r\c 8"18'rdcsl B nl I I 'nqu rcd)
fv.r.d fo, j0 (thin i d"'s fro_ I'cc'(cotaofro!'r'
Sc6l & Signature oltlc Ban ,adtsh Bxnk oflicitrl
(Cenifi ;ate bY Aulhortt.d De'ler)
cndorsed $. aoounr rcl.used inlhe t.ulclle/sp0BPon aturexaflininglhc tick'l
r(b) wc havc erocrcd remirranra of . ... '..." ' "" '-'_"" "-"
(srarc amoud)
inrc'nrsofI,a,a.............Cb.prcr............ofCrET/Bhn8!adcshBaiks
approvalNo.. .....,.... d.1ed..",'."",'" by' "' ..(TTrMTDraft)
See ChnPter5 Prr| I
1/ wc hcrebv ccniry havi'g rcceitcd lhc 'xchrngc issu'd to mert's s aUovc'
,r\
i Srilc otl ncmsrot aPllicablo
9
sisnot,/e(s) of 'tE AP?ti'u nt(t
zN"'
rF(
t
APP.5
Cagc robe c.mpleled by Alrlorised Dcalc! indicatlna Codc No' es tct Code list circDlalcd h! ilrc
Amourt in forcisn cua'ncy
I
I
I
si!tuttre dntl StatnP oftt)'
,4dhaltsed D"ltr