See Chapter 8 | P*a 2 APP.

s I 3

Declaration for remittance received from foreign

country of amount equivalent to US $ 2000/- and above
UWe do herebv declare that Uwe have received remittance of
(A!rcunt and Currency i|l figures al1d in word8)
remitted or
to be remitted by on acco'unt of
(name and addr:ess ofremitting bank)
for the purpose of
(name aad address ofremifter) (purpose of remittance)

(Na6e ofApplioant)
Nationality
Address

Date Signature and Stamp of the

Applicant

Form 'C' Inward Remittance ofTk. equivalent to US $ 200Ol- and above.

Month Country making Purpose Amount in

Paynent (State Currency)

Coded by

Checked by

Purpose of remittance
We hereby certi! that rse are satisfied as to the identity of the applicant and that we have seen documentarjr
evidence which satisfies us as to the bonafides of the declaration made on this form.

Date Signatu,e and Stamp of the

Authorised Dealer

(Space for use by the Bangladesh Baak)

BANGLADESHBANK
Foreign Exchange Policy Departnent

Dated Assistot t Director

Note: Full details must be given for all remittances which are of capital nature. In the case of amounts for investment
in Bangladesh in shares ofbusiness, the reasons why the inyestnent is required must be clearly inilicated. In the case
of the remittanc€ of the sale proceeds of securities the name of the true owner of securities must be cleady indicated.
In the case of the remittance of the sale proceeds of securities the name of the tnre owner of the securities must be ''
given and also the al{noximate date ofpurchase.

Fx - 012