[ Shipper Letter Head ]

BANK ACCOUNT REGISTRATION FORM

I.E.C.NO. ______________________________________________

IFS CODE : ____________________________________________

BANK ACCOUNT NO. : __________________________________

BANK NAME : _________________________________________

BANK ADDRESS : ______________________________________

[ FOR DRAWBACK PURPOSE ]

I DECLARE THAT THE ABOVE PARTICULARS ARE CORRECT.

For_______________________

Name & Designation of exporter Date__________________________

Stamp

CERTIFIED THAT THE ABOVE DETAILS ARE CORRECT

[ Signature of Bank Branch Manager along with the official Seal ]