See Chapter 5| Para 10 APP.
5I6
DBCI,ARATION FOR RN,MITTANCII RECE,IVIID FRONT FORF]IGN
couNTRY OF ANIOUNT EQUIVAI,ENT'rO US $ 2m0/- A]\D AI]OVE
INVe do hereby declare that [/we have received rernittance of
(Amount and Cunency in figttres attcl in words)
renritted or
to be remitted by on account of
(name and address of rertiltting bank)
for thc' puqrose of
narne and acldress of retnitter) (prt rposc- cl1' re ttt i t ta ttcc ;
(Narne of Applicant)
Nationality
Address
Signoture ard Stomp o.f tlte upplirutt
From 'C' : Inward Remittance ol'Tk. equivalent to us $ 2000/-and above.
Month Country nraking Purpose ,Amount in
Payrnent (State Currcnc_v)
Cocled by
Checlicd by
Purpose of remittance
We hereby certify that we are satisf ied as to the identity of the applicant and that we have sccn
docnmentary evidence rvhich satisfles us as to the bonatlcles ol-the declaration Ittadc ou this lirnn.
Sigrtnlure ontl Stantp o.f tlrc
Autltorised Dealer
Contd. P/l
Pagc 2
See Chapter 5| Para 10
(Space firr use by the Bangladesh Banl<)
BANGLADESH RANK
Foreign Exchange Policy Department
Date..,.... Ass i.s t ct nt [) i re c k t r
Note: Full details must begivcn lor all retnittattces which are of capital nature. ln the case til'
amounts for investlrtent in Bangladesh in shares or business, the reasons u'lty the investlrtent is
required must be clearly indicaterJ. In the case of the ru'rnittance ol' the sale proceeds ol'
securities the name of the true owner of the securities nlust be given ancl also the approxitttate
date pf purchase.