Form A2

Application Form-cum-Declaration
(To be completed by the applicant)

Application for drawn of Foreign Exchange Date:-31-08-2023

I. Details of the applicant/Remitter: -

a. Name : Nithya
b. Address : 14/16,CHOSIV APTS,4TH FLOOR RAJA STREET Thiyagaraya Nagar Chennai Tamil Nadu-600017

c. Phone No. : ID NO. CFYPR9732P

d. Email ID : DOB. 10/03/1974

II. Details of the Foreign Exchange required: -

1. Foreign Currency Code(FC) : EUR FE Amount :

FCY Amount in Words .___________________________

2. Purpose Code___________________________ Purpose Description :Student Expenses

III. I authorise you to debit my Saving Bank / Current / RFC / EEFC Account No. N/A /give Cheque
No. N/A of Rs. N/A together with your charges for

Name and address of AD branch/FFMC through which the

transaction has been
Sr.No. Date Currency, Amount INR Amount effected

*a. Issue a draft (DD): Beneficiary Name :Not Applicable Address :Not Applicable
*b. Effect the foreign exchange remittance directly (TT):

1. Beneficiary Name: Lemonway SAS

2. Beneficiary Address: 8 rue du Sentier, 75002 Paris
3. Beneficiary Bank Name: BNP Paribas S.A. Niederlassung Deutschland
4. Bank address : Senckenberganlage 19 60325 Frankfurt am Main, GERMANY
5. Bank Account No./IBAN : DE39512106004270267208
6. Swift Code : BNPADEFFXXX
7. Sort/ABA/BSB/IBAN/Routing No :- DE39512106004270267208
8. Any Other Required Detail :- ba703746810sa02 - Ananya Srinivasan

IV. Correspondent Bank Charges: - BEN OURS SHARE

Details of the remittances made/transactions effected under the Liberalized

Remittance Scheme in the current financial year (April- March)….
Signature of the Applicant

Declaration under FEMA 1999 as per Form A2 I, declare that :

*1) The total amount of foreign exchange purchased from or remitted through, all sources in India during this calendar year including
this application is within the annual limit prescribed by Reserve
Bank of India for the said purpose i.e.(USD) 250000.
*2) Foreign exchange purchased from you is for the purpose indicated above.

Signature of the Applicant