See Chapter 510 Para 10

APP. 5

FORM- C

DECLARATION FOR REMITTANCE RECEIVED FROM FOREIGN

COUNTRY OF AMOUNT EXCEEDING USD 10,000 OR EQUIVALENT

I/We hereby declare that I/we have received remittance of BDT 50,000.00 (Taka Fifty

thousand only) remitted or to be remitted by Commercial Bank of Ceylon on account of

I.H. Khan & Associates, A/C: 1051070000090 for the purpose of Rendering legal service.

(Name of Applicant)
Nationality _________________________
Date……………………
Address _________________________
Form-C : Inward Remittance exceeding USD 10,000 (Ten thousand) or equivalent

Month Country of Ordering Purpose Amount

Customers (State Currency)

Coded by
Checked by
Purpose of remittance: _________________________________________________________
We hereby certify that we are satisfied as to the identity of the applicant and that we have seen
documentary evidence which satisfies us as to the bonafides of the declaration made on this
form.
__________________________
Date: ……………………
Signature and stamp of the
authorized Dealer