Form-C

Para 10 See Chapter 5 10 APP. 5 FORM-C DECLARATION FOR REMITTANCE RECEIVED FROM FOREIGN COUNTRY OF AMOUNT EXCEEDING TO USD 12,000/- OR EQUIVALENT I/We do hereby declare that I/We have received remittance of USD 12,000 (Twelve Thousand Only) (Amount and Currency in figures and in words) remitted or To be remitted by TOYOSHIMA AND CO., LTD., JAPAN (MUFG Bank LTD. Japan) (Name and address of remitting bank) on account of TOYOSHIMA & CO., LTD. for the purpose of OPERATIONAL EXPENSES (Name and address of remitter) (Purpose of remittance) YOSHIHIRO NAGAI (Name of Applicant) Nationality: JAPANESE Date: 28/09/2022 Address: 7/E, Ventura Iconia, Plot: 37, Road- 11, Block- H, Banani, Dhaka Signature and Stamp of the applicant Form C: Inward Remittance exceeding USD 12,000/- (Twelve Thousand) or equivalent. Coded by Month Country of ordering Customers Purpose Amount in (State Currency) Checked by Purpose of remittance Operational Expenses. 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: 28/09/2022 Signature and Stamp of the Authorized Dealer Contd. P/2 Page-2 Para 10 See Chapter 5 10 APP. 5 (Space for use by the Bangladesh Bank) BANGLADESH BANK Foreign Exchange Policy Department Assistant Director Dated................................. 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 Outward Reference AD Code Ref. Year