FORM A-1 Serial No…………………

(For Import Payments Only) (For use of Reserve Bank for India)
Amount
Remitted…………………………. (Application for Remittance in Foreign Currency) A.D Code No. 0005697-3490034
Currency Amount
Equivalent to Rupees…………… Form No…………………………
(To be completed by authorised dealer) (To be filled by authorised dealer)

I/We wish to purchase USD (USD only)

(Name of currency) (Amount in words)
through STATE BANK OF INDIA, I.C Branch, Bahadurgarh-124507(Haryana) for payment to

(Name and Address of the beneficiary of remittance)

Imports into detailed below :
Details of goods Imported or be Imported into India
Section A : Import Licence / Open General Licence Particulars)
O G I ……………………………. …………………………………….. ………………………….
NUMBER PART SCHEDULE SERIAL NUMBER

Import Licence Date of Issue Date of Expiry Face value of Amount to be Balance
Licence endorsed Outstanding
(in Rs.) after
Prefixes Licence No. Suffixes Date @ the remittance
1 2 3 4 5

OPEN GENERAL LICENCE

@ Actual amount endorsed rupees against each licence involved should be stated under this column.
Note: If more than one licence is involved, particulars of all licences should be furnished. If the space in inadequate, a separate
statement may be attached. The amount utilised against each licence should invariably be indicated.

SECTION-C :- Other Particulars

Invoice Details Quantity of Description BTN Country Country Mode of Date
Goods of Classi- of origin from Shipment Shipment
No. & (c.i.f.) Currency Amount Goods fication of goods which air,sea (if not,known
Date (f.o.b.) goods are post trail approximate
c. & f. consigned river date)
etc. transport
etc.

USD

SECTION-C :- Other Particulars

1. Details of forward purchase contact, if and…………………………NIL……………………………………………………………………..
booked against the import (No.& date or contract) (Currency and Amount) (Balance under the
contract)
2. If remittance to be made is less than invoice value…………………NIL……………………………………………………………………

reasons therefore (i.e.part remittance, instalment etc.)……………NIL……………………………………………………………...

I/We hereby declare that the statements made by me/us on this form are true and that I/We have not applied for an authorisation
through any other bank.I/We declare and also understand that the foreign exchange to be acquired by me/us pursuant to this
application shall be used by me/us only for the purpose for which it is acquired and the conditions subject to which the exchange
is granted will be complied with

Name of Applicant(s) Nationality of Applicant(s) INDIAN

(Block Capitals)

Date
(Signature of Applicant(s)
IEC No.:0510048579
 Declaration to be furnished by Applicants(s)

I/We declare that

(a) the goods to which the application relates have been * & imported into India on/our account*
will be
(b) the import it on behalf of @

(c) the invoice value of the goods which is declared on this form is the real value of the goods imported*into India.
to be imported

If the imported Post parcel wrapper (for import by post)*

has been made

OR

If the import I/We undertake to produce within three months to the authorised dealer the relative Custom Stamped Exchange
is to be Copy of Bill entry * Control post parcel wrapper
for imports by cost*

* Strike out item not applicable :

@ Where the import is on behalf Central Government Department or a Company owned by Central/State Government/Statutory
Corporation, Local Body,etc., the name of the Government Corporation etc. should be stated.
FORMAT FOR DECLARATION - CUM - UNDERTAKING
(UNDER SECTION 10(5), CHAPTER III OF THE EXCHANGE FOREIGN EXCHANGE
MANAGEMENT ACT 1999
I/We hereby declare that the transation(s) the details of which are specifically mentioned in the Schedule hereunder does not involve and is not
designed for the purpose of any contravention or evasion of the provisions of the aforesaid Act or of any rule, regulation notification, direction or
order made thereunder.
I/We also here by agree and undertake to give such information/documents, before the Bank undertakes the transaction(s) and as may be required form
time to time as will reasonably
satisfy you about the transactions in terms of, the above declaration.
I/We also understand that if I/We refuse to company with any such requirement of make unsatisfactory compliance there with,the Bank shall refuse in
writing to undertake the transaction
and shall if it has reason to believe that any contravention/evasion is contemplated by me/us report the matter to Reserve Bank of India.
*I/We further declare that the undersigned has/have the authority to give this declaration and undertaking on behalf of firm/company

Date

Signature of Applicant(s)

Space for commencements of the authorised dealer forwarding the application to the Reserve Bank of India for approval (Reference
to the exchange Control Manual paragraph/A.D. Circular in terms of which the reference is made should invariably be cited. If any
remittance application on account of the same import was referred to the Reserve Bank earlier reference to the last correspond-
ence/approval should also be cited)

Date
(Stamp and Signature of authorised Dealer)

Certificate to be furnished by Authorised Dealer (Importer's Banker)

We hereby certify that

(a) this payment is

Put a (i) an advance remittance

tick ( ) (ii) in retirement of bills under Letter of Credit opened through us.

in the (iii) against documents received through our medium for collection.

relevant (iv) On account of documents received direct by the applicant(s) against undertaking furnished by the
letter to submitted Customs stamped Exchange Control copy of Bill of Entry post parcel wrapper
within three months.
(v) On account of documents received direct by the applicant(s) against Customs stamped Exchange
Control copy of Bill of Entry/post wrapper (attached) submitted by the letter.
(vi)
(any other cash to explained)
(b) All the Exchange Control applications regulation to the remittance have been complied with.
(c) the payment of the supplied of goods has been* made through…………………………………………………………………
will be (Name and address of the foreign bank)
We also certify/undertake the relevant Customs-stamped Exchange Control copy of Bill of Entry of post parcel wrapper.
* shall be verified by us within three months (vide certified (ii) and (iii) above).
* has been verified a (v) above.
* shall be obtained from the applicant (s) and forwarded to the Reserve Bank within three months(vide) certificate a(i) and (iv) above)
* strike out item not applicable.

Date
(Stamp and Signature of authorised Dealer)
 FORM A-1 Serial No…………………
(For Import Payments Only) (For use of Reserve Bank for India)
Amount
Remitted…………………………. (Application for Remittance in Foreign Currency) A.D Code No. 0005697-3490034
Currency Amount
Equivalent to Rupees…………… Form No…………………………
(To be completed by authorised dealer) (To be filled by authorised dealer)

I/We wish to purchase USD 3,12,000.00 (USD Three Lac Twelve Thousand only)
(Name of currency) (Amount in words)
through STATE BANK OF INDIA, I.C Branch, Bahadurgarh-124507(Haryana) for payment to
BWE SHANGHAI LTD., 1283 - 50, JINHU ROAD, SHANGHAI - 201206, CHINA
(Name and Address of the beneficiary of remittance)
Imports into detailed below :
Details of goods Imported or be Imported into India
Section A : Import Licence / Open General Licence Particulars)
O G I ……………………………. …………………………………….. ………………………….
NUMBER PART SCHEDULE SERIAL NUMBER

Import Licence Date of Issue Date of Expiry Face value of Amount to be Balance
Licence endorsed Outstanding
(in Rs.) after
Prefixes Licence No. Suffixes Date @ the remittance
1 2 3 4 5

OPEN GENERAL LICENCE

@ Actual amount endorsed rupees against each licence involved should be stated under this column.
Note: If more than one licence is involved, particulars of all licences should be furnished. If the space in inadequate, a separate
statement may be attached. The amount utilised against each licence should invariably be indicated.

SECTION-C :- Other Particulars

Invoice Details Quantity of Description BTN Country Country Mode of Date
Goods of Classi- of origin from Shipment Shipment
No. & (c.i.f.) Currency Amount Goods fication of goods which air,sea (if not,known
Date (f.o.b.) goods are post trail approximate
c. & f. consigned river date)
etc. transport
etc.
CONFORM S350
PI No. FP201121 CIF USD 3,12,000.00 1 SET ALUMINIUM TUBE China China Sea
dt. 13.09.2011 NEW DELHI PRODUCTION
LINE MACHINE

SECTION-C :- Other Particulars

1. Details of forward purchase contact, if and…………………………NIL……………………………………………………………………..
booked against the import (No.& date or contract) (Currency and Amount) (Balance under the
contract)
2. If remittance to be made is less than invoice value…………………NIL……………………………………………………………………

reasons therefore (i.e.part remittance, instalment etc.)……………NIL……………………………………………………………...

I/We hereby declare that the statements made by me/us on this form are true and that I/We have not applied for an authorisation
through any other bank.I/We declare and also understand that the foreign exchange to be acquired by me/us pursuant to this
application shall be used by me/us only for the purpose for which it is acquired and the conditions subject to which the exchange
is granted will be complied with

Name of Applicant(s) AGH ALTECH PVT. LTD. Nationality of Applicant(s) INDIAN

(Block Capitals) K - 25, FATEH NAGAR
NEW DELHI - 110 018

Date
(Signature of Applicant(s)
IEC No.:0510048579

Declaration to be furnished by Applicants(s)

I/We declare that

(a) the goods to which the application relates have been * & imported into India on/our account*
will be
(b) the import it on behalf of @

(c) the invoice value of the goods which is declared on this form is the real value of the goods imported*into India.
to be imported

If the imported Post parcel wrapper (for import by post)*

has been made

OR

If the import I/We undertake to produce within three months to the authorised dealer the relative Custom Stamped Exchange
is to be Copy of Bill entry * Control post parcel wrapper
for imports by cost*

* Strike out item not applicable :

@ Where the import is on behalf Central Government Department or a Company owned by Central/State Government/Statutory
Corporation, Local Body,etc., the name of the Government Corporation etc. should be stated.
FORMAT FOR DECLARATION - CUM - UNDERTAKING
(UNDER SECTION 10(5), CHAPTER III OF THE EXCHANGE FOREIGN EXCHANGE
MANAGEMENT ACT 1999
I/We hereby declare that the transation(s) the details of which are specifically mentioned in the Schedule hereunder does not involve and is not
designed for the purpose of any contravention or evasion of the provisions of the aforesaid Act or of any rule, regulation notification, direction or
order made thereunder.
I/We also here by agree and undertake to give such information/documents, before the Bank undertakes the transaction(s) and as may be required form
time to time as will reasonably
satisfy you about the transactions in terms of, the above declaration.
I/We also understand that if I/We refuse to company with any such requirement of make unsatisfactory compliance there with,the Bank shall refuse in
writing to undertake the transaction
and shall if it has reason to believe that any contravention/evasion is contemplated by me/us report the matter to Reserve Bank of India.
*I/We further declare that the undersigned has/have the authority to give this declaration and undertaking on behalf of firm/company

Date

Signature of Applicant(s)

Space for commencements of the authorised dealer forwarding the application to the Reserve Bank of India for approval (Reference
to the exchange Control Manual paragraph/A.D. Circular in terms of which the reference is made should invariably be cited. If any
remittance application on account of the same import was referred to the Reserve Bank earlier reference to the last correspond-
ence/approval should also be cited)

Date
(Stamp and Signature of authorised Dealer)

Certificate to be furnished by Authorised Dealer (Importer's Banker)

We hereby certify that

(a) this payment is

Put a (i) an advance remittance

tick ( ) (ii) in retirement of bills under Letter of Credit opened through us.

in the (iii) against documents received through our medium for collection.

relevant (iv) On account of documents received direct by the applicant(s) against undertaking furnished by the
letter to submitted Customs stamped Exchange Control copy of Bill of Entry post parcel wrapper
within three months.
(v) On account of documents received direct by the applicant(s) against Customs stamped Exchange
Control copy of Bill of Entry/post wrapper (attached) submitted by the letter.
(vi)
(any other cash to explained)
(b) All the Exchange Control applications regulation to the remittance have been complied with.
(c) the payment of the supplied of goods has been* made through…………………………………………………………………
will be (Name and address of the foreign bank)
We also certify/undertake the relevant Customs-stamped Exchange Control copy of Bill of Entry of post parcel wrapper.
* shall be verified by us within three months (vide certified (ii) and (iii) above).
* has been verified a (v) above.
* shall be obtained from the applicant (s) and forwarded to the Reserve Bank within three months(vide) certificate a(i) and (iv) above)
* strike out item not applicable.

Date
(Stamp and Signature of authorised Dealer)
 FORM A-1 Serial No…………………
(For Import Payments Only) (For use of Reserve Bank for India)
Amount
Remitted…………………………. (Application for Remittance in Foreign Currency) A.D Code No. 0005697-3490034
Currency Amount
Equivalent to Rupees…………… Form No…………………………
(To be completed by authorised dealer) (To be filled by authorised dealer)

I/We wish to purchase USD 100000.00 (USD ONE LAC only)

(Name of currency) (Amount in words)
through STATE BANK OF INDIA, I.C Branch, Bahadurgarh-124507(Haryana) for payment to
MIDAL CABLES LTD. , P.O. BOX 5939 , KINGDOM OF BAHRAIN
(Name and Address of the beneficiary of remittance)
Imports into detailed below :
Details of goods Imported or be Imported into India
Section A : Import Licence / Open General Licence Particulars)
O G I ……………………………. …………………………………….. ………………………….
NUMBER PART SCHEDULE SERIAL NUMBER

Import Licence Date of Issue Date of Expiry Face value of Amount to be Balance
Licence endorsed Outstanding
(in Rs.) after
Prefixes Licence No. Suffixes Date @ the remittance
1 2 3 4 5

OPEN GENERAL LICENCE

@ Actual amount endorsed rupees against each licence involved should be stated under this column.
Note: If more than one licence is involved, particulars of all licences should be furnished. If the space in inadequate, a separate
statement may be attached. The amount utilised against each licence should invariably be indicated.

SECTION-C :- Other Particulars

Invoice Details Quantity of Description BTN Country Country Mode of Date
Goods of Classi- of origin from Shipment Shipment
No. & (c.i.f.) Currency Amount Goods fication of goods which air,sea (if not,known
Date (f.o.b.) goods are post trail approximate
c. & f. consigned river date)
etc. transport
etc.
PI. No. CIF EC RODS
2011/02/AK NHAVA USD 100000 40.00 MT GRADE 1100, 76041039 Bahrain Bahrain Sea 31.01.2012
Dt. 29.11.2011 SHEVA DIA 12.00 MM

SECTION-C :- Other Particulars

1. Details of forward purchase contact, if and…………………………NIL……………………………………………………………………..
booked against the import (No.& date or contract) (Currency and Amount) (Balance under the
contract)
2. If remittance to be made is less than invoice value…………………NIL……………………………………………………………………

reasons therefore (i.e.part remittance, instalment etc.)……………NIL……………………………………………………………...

I/We hereby declare that the statements made by me/us on this form are true and that I/We have not applied for an authorisation
through any other bank.I/We declare and also understand that the foreign exchange to be acquired by me/us pursuant to this
application shall be used by me/us only for the purpose for which it is acquired and the conditions subject to which the exchange
is granted will be complied with

Name of Applicant(s) AGH ALTECH PVT. LTD. Nationality of Applicant(s) INDIAN

(Block Capitals) K - 25, FATEH NAGAR
NEW DELHI - 110 018

Date
(Signature of Applicant(s)
IEC No.:0510048579

Declaration to be furnished by Applicants(s)

I/We declare that

(a) the goods to which the application relates have been * & imported into India on/our account*
will be
(b) the import it on behalf of @

(c) the invoice value of the goods which is declared on this form is the real value of the goods imported*into India.
to be imported

If the imported Post parcel wrapper (for import by post)*

has been made

OR

If the import I/We undertake to produce within three months to the authorised dealer the relative Custom Stamped Exchange
is to be Copy of Bill entry * Control post parcel wrapper
for imports by cost*

* Strike out item not applicable :

@ Where the import is on behalf Central Government Department or a Company owned by Central/State Government/Statutory
Corporation, Local Body,etc., the name of the Government Corporation etc. should be stated.
FORMAT FOR DECLARATION - CUM - UNDERTAKING
(UNDER SECTION 10(5), CHAPTER III OF THE EXCHANGE FOREIGN EXCHANGE
MANAGEMENT ACT 1999
I/We hereby declare that the transation(s) the details of which are specifically mentioned in the Schedule hereunder does not involve and is not
designed for the purpose of any contravention or evasion of the provisions of the aforesaid Act or of any rule, regulation notification, direction or
order made thereunder.
I/We also here by agree and undertake to give such information/documents, before the Bank undertakes the transaction(s) and as may be required form
time to time as will reasonably
satisfy you about the transactions in terms of, the above declaration.
I/We also understand that if I/We refuse to company with any such requirement of make unsatisfactory compliance there with,the Bank shall refuse in
writing to undertake the transaction
and shall if it has reason to believe that any contravention/evasion is contemplated by me/us report the matter to Reserve Bank of India.
*I/We further declare that the undersigned has/have the authority to give this declaration and undertaking on behalf of firm/company

Date

Signature of Applicant(s)

Space for commencements of the authorised dealer forwarding the application to the Reserve Bank of India for approval (Reference
to the exchange Control Manual paragraph/A.D. Circular in terms of which the reference is made should invariably be cited. If any
remittance application on account of the same import was referred to the Reserve Bank earlier reference to the last correspond-
ence/approval should also be cited)

Date
(Stamp and Signature of authorised Dealer)

Certificate to be furnished by Authorised Dealer (Importer's Banker)

We hereby certify that

(a) this payment is

Put a (i) an advance remittance

tick ( ) (ii) in retirement of bills under Letter of Credit opened through us.

in the (iii) against documents received through our medium for collection.

relevant (iv) On account of documents received direct by the applicant(s) against undertaking furnished by the
letter to submitted Customs stamped Exchange Control copy of Bill of Entry post parcel wrapper
within three months.
(v) On account of documents received direct by the applicant(s) against Customs stamped Exchange
Control copy of Bill of Entry/post wrapper (attached) submitted by the letter.
(vi)
(any other cash to explained)
(b) All the Exchange Control applications regulation to the remittance have been complied with.
(c) the payment of the supplied of goods has been* made through…………………………………………………………………
will be (Name and address of the foreign bank)
We also certify/undertake the relevant Customs-stamped Exchange Control copy of Bill of Entry of post parcel wrapper.
* shall be verified by us within three months (vide certified (ii) and (iii) above).
* has been verified a (v) above.
* shall be obtained from the applicant (s) and forwarded to the Reserve Bank within three months(vide) certificate a(i) and (iv) above)
* strike out item not applicable.

Date
(Stamp and Signature of authorised Dealer)
 FORM A-1 Serial No…………………
(For Import Payments Only) (For use of Reserve Bank for India)
Amount
Remitted…………………………. (Application for Remittance in Foreign Currency) A.D Code No. 0005697-3490034
Currency Amount
Equivalent to Rupees…………… Form No…………………………
(To be completed by authorised dealer) (To be filled by authorised dealer)

I/We wish to purchase USD 17826.00 (USD Seventeen Thousand Eight Hundred Twenty Six only)
(Name of currency) (Amount in words)
through STATE BANK OF INDIA, I.C Branch, Bahadurgarh-124507(Haryana) for payment to
TONGLING JINGXUN SPECIAL ENAMELLED WIRE CO. LTD. ADD: TONGLING ECONOMIC TECHNOLOGICAL DEVELOPMENT ZONE, ANHUI PROVINCE, 244000, CHINA
(Name and Address of the beneficiary of remittance)
Imports into detailed below :
Details of goods Imported or be Imported into India
Section A : Import Licence / Open General Licence Particulars)
O G I ……………………………. …………………………………….. ………………………….
NUMBER PART SCHEDULE SERIAL NUMBER

Import Licence Date of Issue Date of Expiry Face value of Amount to be Balance
Licence endorsed Outstanding
(in Rs.) after
Prefixes Licence No. Suffixes Date @ the remittance
1 2 3 4 5

OPEN GENERAL LICENCE

@ Actual amount endorsed rupees against each licence involved should be stated under this column.
Note: If more than one licence is involved, particulars of all licences should be furnished. If the space in inadequate, a separate
statement may be attached. The amount utilised against each licence should invariably be indicated.

SECTION-C :- Other Particulars

Invoice Details Quantity of Description BTN Country Country Mode of Date
Goods of Classi- of origin from Shipment Shipment
No. & (c.i.f.) Currency Amount Goods fication of goods which air,sea (if not,known
Date (f.o.b.) goods are post trail approximate
c. & f. consigned river date)
etc. transport
etc.
ROUND
PI No. 111128 CIF USD 17826 3300 kgs ENAMELED China China Sea 31.01.2012
dt. 28.11.2100 NEW DELHI ALUMINUM WIRE

SECTION-C :- Other Particulars

1. Details of forward purchase contact, if and…………………………NIL……………………………………………………………………..
booked against the import (No.& date or contract) (Currency and Amount) (Balance under the
contract)
2. If remittance to be made is less than invoice value…………………NIL……………………………………………………………………

reasons therefore (i.e.part remittance, instalment etc.)……………NIL……………………………………………………………...

I/We hereby declare that the statements made by me/us on this form are true and that I/We have not applied for an authorisation
through any other bank.I/We declare and also understand that the foreign exchange to be acquired by me/us pursuant to this
application shall be used by me/us only for the purpose for which it is acquired and the conditions subject to which the exchange
is granted will be complied with

Name of Applicant(s) AGH ALTECH PVT. LTD. Nationality of Applicant(s) INDIAN

(Block Capitals) K - 25, FATEH NAGAR
NEW DELHI - 110 018

Date
(Signature of Applicant(s)
IEC No.:0510048579

Declaration to be furnished by Applicants(s)

I/We declare that

(a) the goods to which the application relates have been * & imported into India on/our account*
will be
(b) the import it on behalf of @

(c) the invoice value of the goods which is declared on this form is the real value of the goods imported*into India.
to be imported

If the imported Post parcel wrapper (for import by post)*

has been made

OR

If the import I/We undertake to produce within three months to the authorised dealer the relative Custom Stamped Exchange
is to be Copy of Bill entry * Control post parcel wrapper
for imports by cost*

* Strike out item not applicable :

@ Where the import is on behalf Central Government Department or a Company owned by Central/State Government/Statutory
Corporation, Local Body,etc., the name of the Government Corporation etc. should be stated.
FORMAT FOR DECLARATION - CUM - UNDERTAKING
(UNDER SECTION 10(5), CHAPTER III OF THE EXCHANGE FOREIGN EXCHANGE
MANAGEMENT ACT 1999
I/We hereby declare that the transation(s) the details of which are specifically mentioned in the Schedule hereunder does not involve and is not
designed for the purpose of any contravention or evasion of the provisions of the aforesaid Act or of any rule, regulation notification, direction or
order made thereunder.
I/We also here by agree and undertake to give such information/documents, before the Bank undertakes the transaction(s) and as may be required form
time to time as will reasonably
satisfy you about the transactions in terms of, the above declaration.
I/We also understand that if I/We refuse to company with any such requirement of make unsatisfactory compliance there with,the Bank shall refuse in
writing to undertake the transaction
and shall if it has reason to believe that any contravention/evasion is contemplated by me/us report the matter to Reserve Bank of India.
*I/We further declare that the undersigned has/have the authority to give this declaration and undertaking on behalf of firm/company

Date

Signature of Applicant(s)

Space for commencements of the authorised dealer forwarding the application to the Reserve Bank of India for approval (Reference
to the exchange Control Manual paragraph/A.D. Circular in terms of which the reference is made should invariably be cited. If any
remittance application on account of the same import was referred to the Reserve Bank earlier reference to the last correspond-
ence/approval should also be cited)

Date
(Stamp and Signature of authorised Dealer)

Certificate to be furnished by Authorised Dealer (Importer's Banker)

We hereby certify that

(a) this payment is

Put a (i) an advance remittance

tick ( ) (ii) in retirement of bills under Letter of Credit opened through us.

in the (iii) against documents received through our medium for collection.

relevant (iv) On account of documents received direct by the applicant(s) against undertaking furnished by the
letter to submitted Customs stamped Exchange Control copy of Bill of Entry post parcel wrapper
within three months.
(v) On account of documents received direct by the applicant(s) against Customs stamped Exchange
Control copy of Bill of Entry/post wrapper (attached) submitted by the letter.
(vi)
(any other cash to explained)
(b) All the Exchange Control applications regulation to the remittance have been complied with.
(c) the payment of the supplied of goods has been* made through…………………………………………………………………
will be (Name and address of the foreign bank)
We also certify/undertake the relevant Customs-stamped Exchange Control copy of Bill of Entry of post parcel wrapper.
* shall be verified by us within three months (vide certified (ii) and (iii) above).
* has been verified a (v) above.
* shall be obtained from the applicant (s) and forwarded to the Reserve Bank within three months(vide) certificate a(i) and (iv) above)
* strike out item not applicable.

Date
(Stamp and Signature of authorised Dealer)