NEW A2 FORM

A2 CUM APPLICATION FORM FOR FOREIGN
EXCHANGE PAYMENTS OVERSEAS UNDER LRS
To RBL Bank LTD, Branch : AD Code: 6160073-6000009
Applicant Name :
Applicant Address :
PAN No CIF ID
Details of Foreign Exchange Required
A. Remittance Yes No Currency Type Amount in FCY
B. Forex Card Yes No Purpose Code and Description
C. FCY Cash Yes No Travel Destination Source of Fund: Own Fund Family Fund Loan
Payment Details
I/We authorize RBL Bank to debit my account: RBL Account No: to process the foreign currency
remittance / issue DD / FCY Notes / Forex Card as instructed including government levies and bank charges.
Payment Details For Non-RBL Bank Account Holders
Type of Payment Instrument: RTGS NEFT IMPS Cheque UTR No / Cheque No.
BENEFICIARY DETAILS
Beneficiary Name FIRST MIDDLE LAST
Residential Status of the Beneficiary: Indian Resident NRI OCI
Beneficiary Address
Beneficiary Bank Name

Beneficiary Bank
Address
Account Number Swift Code
IBAN Number
Routing No. BSB/Sort Code/Transit No
Student's Name FIRST MIDDLE LAST
Student ID/REF. No. (If required)
INTERMEDIARY BANK (if any)
Bank Name
Bank Address
Account Number Swift Code

Bank Charges (Please tick whichever is applicable) BEN OUR SHA
Declaration (Under FEMA 1999)
I, ………….........................…….…………(Name), hereby declare that the total amount of foreign exchange purchased from or remitted through, all sources in
India during the immediate financial year including this application is within the overall limit of USD 250,000/-(US Dollar Two hundred and Fifty Thousand
only) under the Liberalized Remittance Scheme (LRS) prescribed by the Reserve Bank of India and certify that the source of funds is as declared above
and the foreign exchange will not be used for prohibited purposes as defined in law and FEMA Further, I Declare that the transaction mentioned above
does not involve, and is not designed for any purpose for which the drawing of foreign exchange is prohibited under rule 3 of the FEMA Current A/c
transactions Rules, 2000
Declare that the transaction mentioned above does not involve, and is not designed for any purpose related to end use like investment/purchase/
trading/commission/sale/proceeds/redemption/repatriation of Crypto currencies / Virtual Currencies / mutual funds or shares or any other instrument
including capital instrument of a company dealing in Crypto currencies / Virtual Currencies, further The source of funds for the proposed Remittance is
NOT proceeds from redemption of investment in Cryptocurrency /Bitcoins/Virtual Currencies and also end use of.
I / We, being a person(s) resident in India, hereby declare that for transactions done under the LRS for resident individuals, issued and amended by RBI
from time to time, is not in the nature of remittance for margin or margin calls to overseas exchanges / overseas counter parties under this scheme.
In case the remittance is made under purpose of Investment in shares, I / we confirm that the remittance is towards Investment in Equity and not for
trading in forex or any other margin-based trading or any other purpose prohibited as per the terms and conditions of the LRS for resident Individuals.
Further, I / we, confirm that the remittance is not for lottery / margin trading or illegal activities and not for FCCBs issued by Indian Company/ies for
trading in secondary market.
Agree and undertake to give such information / documents as will reasonably satisfy you about this transaction in terms of the above declaration as and
when called for by RBL Bank & I Understand that if I/We refuse to comply with any such requirement or make any unsatisfactory compliance herewith,
if RBL Bank has reason to believe that my contravention / evasion is contemplated by me / us the bank reserves the right to refuse the transaction
including report the matter to Reserve Bank of India
LRS-A2/12092023/Ver 1.0
Declaration for Relationship with the beneficiary for remittances under Family Maintenance
I………………...................……………...………, hereby declare that the beneficiary of this remittance is my……………………… (Relationship as per Sec VI of Companies Act.) The
document evidencing the relationship proof has been submitted correctly.
Details of remittance made under the LRS in the current financial year April to March (20___ - 20___)
Sr. No. Date Amount (USD Eq) Name and Address of AD Branch / FFMC through which the transaction has been effected
Please add a separate sheet for more transactions.

Date: D D M M Y Y Y Y
Signature of the Applicant ..................................................................................
Certificate by the Authorised Dealer

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.
Amount in INR Exchange Rate
Date: D D M M Y Y Y Y Branch Name and Code
Name and Designation of Authorised Person Signature & Stamp
LRS-A2/12092023/Ver 1.0

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NEW A2 FORM

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A2 CUM APPLICATION FORM FOR FOREIGN

EXCHANGE PAYMENTS OVERSEAS UNDER LRS

To RBL Bank LTD, Branch : AD Code: 6160073-6000009

Beneficiary Bank Name

Account Number Swift Code

Please add a separate sheet for more transactions.

Certificate by the Authorised Dealer

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