Form A2

Application for remittances abroad

AD Code No. 0560058-8000009
Form No.
Currency GBP
Amount 50.00
Equivalent to INR 5211
Application for Remittance Abroad
I MOHIT KUMAR
PAN NO. EKXPK1061C (VERIFIED)
Address ALWAR RAJASTHAN 301702
Address ALWAR RAJASTHAN 301702
have authorised DCB REMIT to debit my resident savings Bank account number 107001544575 or will remit to DCB Bank
account from my existing bank account and pay to DCB BANK LTD for effecting the below mentioned foreign exchange
remittance directly.
1) Beneficiary's Name Girish Hotchandani
2) Beneficiary Address 120 Ashcroft RdLuton LU2 9AX ,luton ,Bedfordshire
LU29AX
3) Name and address of the Beneficiary Bank Monzo bank, Monzo bank
Broadwalk house , 5 appold
St, london
EC2A2AG
United kingdom
4) Beneficiary Bank Account Number 45251638
To be filled by residents only if the remittance is made under LRS:
Sr.No. Whether Purpose Code Descriptions
under LRS
(Yes / No)
1 Yes S0305 Overseas Education

Source of funds : Salary or wages. If the source is Education Loan from any Financial Institution in India for the remittance
purpose of Education
Name of Lender : .
(Please submit - a) Sanction Letter and b) Statement of Account showing the credit of Loan proceeds - for reduced rate of TCS)
Declaration
(Under FEMA 1999)
I, MOHIT kumar, declare that total amount of foreign exchange purchased from or remitted through, all sources in India during the
financial year including this application in within the overall limit of the Liberlised Remittance Scheme prescribed by the Reserve
Bank of India 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. Foreign exchange purchased from you is for the purpose indicated above.
I hereby declare that the transaction 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 there under.
I also hereby agree and undertake to give such information/documents as will reasonably satisfy you about this transaction in
terms of the above declaration.
I also undertake that if I refuse to comply with any such requirements or make only unsatisfactory compliance therewith, 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.
Declaration for TCS
I, MOHIT KUMAR, do hereby declare that the aggregate amount of Foreign Exchange purchased from and / or remitted through
all sources under the Liberalised Remittance Scheme during the Financial Year April-March 2020-2021 so far is equivalent to
Rs.5,116.50 only).
Details of the remittance made/transactions effected under the Liberalized Remittance Scheme in the current Financial
Year(April - March)2020-2021
Sr.No. Date Amount Name and address of AD branch through which the transaction has been effected
1 22/02/2021 GBP 50.00 DCB Remit

Name of the applicant:MOHIT kumar

Date:24-02-2021

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Certificate by the DCB Bank Limited:
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 from time to time under the scheme.
Date: 24-02-2021
Place:ALWAR

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