(To be printed on White paper)

FORM A3
(To be completed for transfer of rupees
from/to the account of a non-resident
bank other than for transactions
with the public in India)

A.D.Code No._______________________
Form No.___________________________
(To be filled by authorised dealer)
.................................
Serial No.__________________________
(For use of Reserve Bank of India)

We have effected/seek permission to effect the following transfer.

_____________________________________________________________________________
_
From the account of_____________________________________________________________
(Full title of account of non-resident bank debited, stating
____________________ at
______________________________________________________
country of residence)
(Name of authorised dealer with whom account is kept)
for transfer to__________________________________________________________________
(Full title of account of non-resident bank credited, stating
____________________ at ______________________________________________________
country of residence)
(Name of authorised dealer with whom account is kept)
Amount Rs.____________ ______________________________________________________
(in figures)
(in words)
The purpose of the transfer is_____________________________________________________
_____________________________________________________________________________
We certify that Exchange Control regulations relating to the above transfer have been complied
with. Similar transaction was approved by the Reserve Bank vide approval No....................
dated ............
Date:.........

Stamp

...............................................................................
(Signature of Authorised Official)
Name .....................................................................
Designation............................................................
Name and Address.................................................
of Authorised Dealer .............................................

_____________________________________________________________________________
_

__
NOTES:

1. Where accounts of non-resident banks are put in funds against purchase of

foreign currency, the transferor portion of the form may be completed indicating
merely "Against Purchase of __________ __________"
(currency)
(amount)
2. Where debits to accounts of non-resident banks are made towards sale of
foreign currency to them, the transferee portion of the form may be
completed indicating merely "Against sale of ___________
__________"
(currency) (amount)
3. While forwarding the application to Reserve Bank for approval, reference to
Exchange Control Manual paragraph/AD circular in terms of which the reference
is being made should invariably be cited.