FORM FC – 4

[See rule 17]

Darpan ID***

The Secretary to the Government of India, Ministry of

Home Affairs,
Foreigners Division (FCRA Wing)
Major Dhyan Chand National Stadium, India Gate, New Delhi-110002
***Note: - Furnishing of Darpan ID shall be optional.

Subject: Account of Foreign Contribution (FC) for the year ending on the
31st March
1. FCRA registration/ prior permission number and date:
2. Details of receipt of foreign contribution:

(i) Foreign Contribution received in cash/ kind (value):

(a) Brought forward foreign contribution at the beginning of the year (Rs.):
(b) Income during the year*:
(i) Interest:
(ii) Other receipts from projects/activities:

S No. Name and location of Year of commencement of the Income during the year
project/ activity project / activity (Rs.)
1
Total

(c) Foreign Contribution received during the financial year:

(i) Directly from a foreign source:
(ii) From a local source:
(d) Total Foreign Contribution (a+b+c) (Rs.):

* i.e. interest accrued on foreign contribution, or any other income derived from foreign contribution, e.g. sale proceeds
from assets created from foreign contribution, or interest thereon during the year, income from projects/activities.

(ii) (a) Donor wise detail of foreign contribution received:

Sl. Name of Institutional / Details of the Purpose(s) for Specific

donor( Individual donor: official which Rs
No.
s) Address; e- received
mail address; project
(Social,
Website
Cultural,
address;

Economic,
Religious)
(1) (2) (3) (4) (5) (6) (7)

(b) Cumulative purpose-wise amount of all foreign contribution donations received:

 3. Details of utilisation of foreign contribution:

(a) Details of activities/projects for which foreign contribution has been received and utilised (in rupees)
Receipt
Previous balance
during the Utilised
Balance
Sl. Name of year
No. project/ In cash In In In In In kind In In
activity
kind cash kind cash cash kind
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)
(b) Details of utilisation of foreign contribution:

(i) Total Utilisation** for projects as per aims and objectives of the association (Rs.):
(ii) Total administrative expenses as provided in rule 5 of the Foreign Contribution (Regulation) Rules, 2011
(Rs.):

** It is affirmed that the utilisation of foreign contribution is not in contravention of the provisions contained in the
Foreign Contribution (Regulation) Act, 2010 (42 of 2010) and more particularly in section 9 and section 12 of the Act which,
inter-alia, states that the acceptance of foreign contribution is not likely to affect prejudicially:

(A) the sovereignty and integrity of India; or

(B) the security, strategic, scientific or economic interest of the State; or
(C) the public interest; or
(D) freedom or fairness of election to any Legislature; or
(E) friendly relations with any foreign State; or
(F) harmony between religious, racial, social, linguistic or regional groups, castes or
communities.

(c) Total purchase of fresh assets (Rs.)

Sl. No. Activity in the name of Details Purpose Total (in Rs.)
Association
(i) Creation of movable assets

(ii) Creation of Immovable assets

Total

(d) FC transferred to other associations

Sl. Name of the association Date Purpose Amount

No.
(1) (2) (3) (4) (5)
Total

(e) Total utilisation in the year (Rs.) (b+c+d):

4. Details of unutilised foreign contribution:

(i) Total FC invested in term deposits (Rs.):

Sr. Details Total (in Rs.)

No.
(i) Opening Balance of FD
(ii) FD made during the year
(iii) Less: realisation of previous FD
Closing balance of FD
(ii) Balance of unutilised foreign contribution, in cash/bank, at the end of the year (Rs):

(a) Cash in hand:

(b) in FC designated bank account:
(c) in utilisation bank account(s):
5. Details of foreigners as Key functionary/working/associated:
6. Details of Land and Buildings remained unutilised for more than two years:

Sl. Location of Land Year of acquisition Purpose of acquisition Reason of

No. and Building unutilisation

(1) (2) (3) (4) (5)

7. (a) Details of designated FC bank account for receipt of Foreign Contribution (As on 31 st March of the
year ending):

Name of the Branch Address Phone No. E-mail IFSC Account Date of
Bank (with PIN code) Code No. Opening
Account
(1) (2) (3) (4) (5) (6) (7)

(b) Details of all utilisation bank accounts for utilisation of Foreign Contribution (As on 31st March of the
year ending):

Name of the Branch Address Phone No. E-mail IFSC Account Date of
Bank (with PIN code) Code No. Opening
Account
(1) (2) (3) (4) (5) (6) (7)
Declaration
I hereby declare that the above particulars furnished by me are true and correct.
I also affirm that the receipt of foreign contribution and its utilisation have not been violative of any of the provisions
of the Foreign Contribution (Regulation) Act, 2010 (42 of 2010), and the rules, notifications or orders issued
thereunder from time to time and the foreign contribution was utilised for the purpose(s) for which the association
was granted registration/ prior permission by the Central Government.
Place:
Date:
[Name of the Chief Functionary
(Chairperson/President/Secretary/CEO/MD) in block letters]
(Seal of the Association)
 Certificate to be given by Chartered Accountant
I/We have audited the account of (name of
Association and its full address including State, District and Pin Code, if registered society, its registration number
and State of registration) for the financial year ending the 31st March and examined
all relevant books and vouchers and certify that according to the audited account:
(i) the brought forward foreign contribution at the beginning of the financial year was Rs. ;
(ii) foreign contribution of / worth Rs. was received by the Association during the
financial year ;
(iii) interest accrued on foreign contribution and other income derived from foreign contribution or interest
thereon of/worth Rs. was received by the Association during the financial year ;
(iv) the balance of unutilised foreign contribution with the Association at the end of the financial year
was Rs. ;
(v) Certified that the Association has maintained the accounts of foreign contribution and records relating
thereto in the manner specified in section 19 of the Foreign Contribution (Regulation) Act, 2010 (42 of 2010) read
with rule 17 of the Foreign Contribution (Regulation) Rules, 2011.
(v) The information in this certificate and in the enclosed Balance Sheet and statement of Receipt and
Payment is correct as checked by me/us.
(vi) The association has utilised the foreign contribution received for the purpose(s) it is registered/ granted
prior permission under the Foreign Contribution (Regulation) Act, 2010 (42 of 2010).

Place:
Date:

Signature of Chartered Accountant

(Seal, Address and Registration number)