International Banking Division
4th Floor, A Wing, Plot No. 4, Sector 10, Dwarka New Delhi -110075
Annexure I of Forex Circular No.Dated15.01.2020
APPLICATION CUM FORM FOR DRAWL OF FOREIGN EXCHANGE-LOADING/RELOADING IN
WORLD TRAVEL CARD
The Branch Head
Punjab National
Bank,B/O
New Delhi.
A. Details of theApplicant:
Name of the Applicant
Card Number
Address
Applicant Email ID and contact number
PAN No. ( Mandatory)
Purpose of Loading/Re-loading
Amount of FC/Currency of Remittance /(USD/GBP/EUR)
I authorize you to debit my Saving AccountNo
With you for effecting remittance as detailed above at current market ratealong with your charges and
applicable government tax. I ensure that I will maintain sufficient balance in the account equivalent to
remittance amount plus bank charges. I understand that Bank shall not be liable for any consequences
arising out of the Bank's failure to carry out such instructions due to non-maintenance of balance in the
account and I shall be responsible to repay any loss incurred due to adverse fluctuation in the currency
rates with interest due to non-maintenance of the sufficient balance in the account.
Declaration under FEMA 1999 as per Form
I declare that the total amount of foreign exchange
purchased from or remitted through, all sources in India, during the financial year including
this application is within the overall limit of the Liberalized Remittance Scheme prescribed
by the Reserve Bank of India i.e. USD 2,50,000 and certify that the source of funds for
making the said remittance belongs to me and the foreign exchange will not be used for
prohibited purposes.
Details of the remittances made/transactions effected under the Liberalized Remittance
Scheme in the current financialyear(April 20 to March 20 is as follows:-
Sr. Date Amount in Purpose Name and address of AD branch through which
No. Foreign the transaction has been effected
Currency
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International Banking Division
4th Floor, A Wing, Plot No. 4, Sector 10, Dwarka New Delhi -110075
Declaration by Applicant
I declarethat-
1. I am a person resident in India.
2. I shall be responsible and liable for any incorrect detail provided by me /us.
3. I shall also hereby agree and undertake to give such information / documents as will reasonably
satisfy you about this transaction in terms of the abovedeclaration.
4. I have not availed any loan / credit / borrowings for remitting under Liberalized Remittance Scheme
for Capital Accounttransactions
5. The remittance is not being requested for any purpose specifically prohibited under Schedule I or any
item restricted under Schedule II of Foreign Exchange Management (Current Account Transaction)
Rules, 2000.
6. The drawl is not being requested for any transaction not permissible under FEMA.
Declaration-cum-undertaking under Sec 10(5), Chapter III of FEMA 1999, is
enclosed as under:
I hereby agree and undertake to give such information / documents for drawal of foreign
currency for WTC.
Yours faithfully,
Signature of Applicant/GuardianAccount Number:
Date:
Certificate by the Branch
This is to certify that the remittance is not being made by/to ineligible entities and that the
remittance is in conformity with the instructions issued by the Reserve Bank of India from time to
time under the Liberalized Remittance Scheme(The total amount of remittance made by the
.
Name and designation of the authorizedofficial:
Signature: Stamp andseal:
Date andPlace:
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International Banking Division
4th Floor, A Wing, Plot No. 4, Sector 10, Dwarka New Delhi -110075
Purpose Codes for Reporting under LRS
Purpose Group Purpose Description
Name Code
Capital Account S0005 Purchase of Immovable Property
Transactions S0001 Indian Portfolio investment abroad in equity shares
S0002 Indian Portfolio investment abroad in debt instruments
S0003 Indian Direct investment abroad (in branches & wholly owned
subsidiaries) in equity Shares
S0004 Indian Direct investment abroad (in subsidiaries and associates) in
debt instruments
S0021 Payments made on account of sale of share under Employee stock
option
S0022 Investment in Indian Depositories Receipts (IDRs)
S0023 Opening of foreign currency account abroad with a bank under LRS
Current Account S0301 Business travel.
Transactions S0303 Travel for pilgrimage
S0304 Travel for medical treatment
S0305 Travel for education (including fees, hostel expenses etc.)
S0306 Travel for Employment and Personal
S1301 Maintenance of Close Relatives
S1108 Medical Treatment
S1107 Studies Abroad
S1307 Emigration
S0011 Loans extended to Non-Residents close relative
S0603 Health Insurance
S1302 Gift
S1303 Donation
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