APPLICATION FOR PAYMENT OF DIRECT IMPORT BILLS

(To be completed by the applicant in block letters using black ink pen) Branch Name:
We have imported following commodity/goods and request you to remit as per details given below towards the import of goods:
Date:

Commodity: HS Code:

Purpose of import : Type of Goods : Capital Non-Capital

Foreign Currency FC
Amount
FC Amt in Figures In Words

Value Date of Remittance : Foreign Bank Charges : SHA OUR BEN

Country of Origin of Goods: Country from which goods shipped:

Remitter’s Name

IEC No. PAN No.

Address of Remitter

Name of contact Person

Mobile No E-mail id
Beneficiary name

Beneficiary Address

Country of Beneficiary:

Beneficiary’s Bank
(Name and Address)
Beneficiary’s Bank Account or IBAN Number

SWIFT & SORT Code details of beneficiary Bank (In case of TT)
IBAN for remittancemade to UK, Transit Code for remittance
Europe, Bahrain Saudi Arabia & UAE made to Canada
Sort Code for remittance to UK (or) SWIFT code (or) routing
BSB Code for remittance to Australia Number of beneficiary bank

DATE D D M M Y Y Y Y

(Authorised Signatory with Company/Firm seal)

Enclose necessary supporting documents as per Annexure-1. Page 1/3

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 APPLICATION FOR PAYMENT OF DIRECT IMPORT BILLS

Purpose of import:

The details to be mentioned in Swift

message for beneficiary information

Part Payment of Total Shipment Yes No

Is the Beneficiary same as the Overseas Supplier Yes No

Is the remittance being made for Merchanting Trade Transaction Yes No

Authority to debit bank account

Account Type Account Number Currency

EEFC

CA/ CC/ OD

Authority to debit charges( if different from above account )

CA/ CC/ OD

Forward contract details :

Contract Number: Date:

Contract Amount: Due Date of Contract:

Amount to be utilized for remittance

Reasons for delayed payment (Applicable if payment is being made after stipulated time as per FEMA guidelines; i.e. after 90days/180 days from the date
of shipment): ________________________________________________________________________________________________________(Please
submit documentary evidences)

DATE
D D M M Y Y Y Y

(Authorised Signatory with Company/Firm seal)

GENERAL DECLARATION
I/We confirm that the goods being imported by me/us are not covered under Negative list of imports as per the latest Foreign Trade Policy (as
amended till date) notified by Government of India, Ministry of Commerce & Industry, Department of Commerce, Directorate General of Foreign Trade,
New Delhi. I/We are eligible to import the above mentioned goods under the current Export and Import Policy in place. I/We confirm that said goods
imported/being imported by me/us are not restricted for import through specific licensing under the above mentioned policy and amendments.

OR
Original Exchange control copy of the License number ______________ dated_________ for the amount of ____________ is enclosed. I/We declare
that the license is valid and have not been cancelled by the DGFT. (In case item is under Negative List of import).

I/We declare that the goods to which the application relates are/will be imported into India on my/our account. I/We declare that the import is on behalf
of ___________________________ .

I/We declare that the invoice value of the goods imported/being imported into India is the real value of the goods

I/We enclose the custom stamped Exchange Control Copy of Bill of Entry/Copy of Bill of Entry (in case of IDPMS)/ Courier wrapper/ Postal Appraisal
Form/ Custom Assessment Certificate/ CA certificate (in case of Service Export/Import) as an evidence of import of the said goods.

DATE
D D M M Y Y Y Y
(Authorised Signatory with Company/Firm seal)

Enclose necessary supporting documents as per Annexure-1.

Page 2/3 2/3
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 APPLICATION FOR PAYMENT OF DIRECT IMPORT BILLS

OR

I/We declare that we will submit within 90 days from the date of remittance the custom stamped Exchange Control copy of Bill of Entry/Copy of Bill of
Entry(in case of IDPMS)/Post parcel wrapper(for imports by post)/Courier Bill of Entry(for imports through courier)/ CA certificate (in case of Service
Export/Import) to Bank of Baroda .

I/We further declare that we have not made payment against the same invoice/contract through any other AD Bank.

I/We agree that in the event of transaction could not be executed/debited to my/ our account after submitting the request for processing to the bank on
account of insufficient/ unclear balance at the same time of execution of the transaction in my/ our account any exchange losses incurred in this
connection due to reversal of the Forex deal can be charged to my/our Bank of Baroda account.

I/We agree that in the event the transaction is cancelled or revoked by me/us after submitting the request for processing to the bank any exchange
losses incurred in this connection can be charged to my/our Bank of Baroda account. I/We further agree that once the funds remitted by me/us have
been transmitted by Bank of Baroda to the correspondent and/or beneficiary banks, Bank of Baroda shall not be responsible for any delays in the
disbursement of such funds including the withholding of such funds by the correspondent and/or beneficiary banks. I/We further agree that once the
funds remitted by me / us have been transmitted by Bank of Baroda, intermediary Bank charges may be levied by Correspondent and / or Beneficiary
Banks, which may vary from bank to bank.

I/We agree that in the event the transaction being rejected by the beneficiary bank because of incorrect information submitted by me, any charges levied
by the beneficiary bank or exchange losses incurred in this connection can be charged to my Bank of Baroda account.

I/We also understand that if I/we refuse to comply with any such requirement 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 in contemplated by me/us, report that matter to
the RBI.

I/We also agree that the exchange rate will be applicable at the time of deal booking and may vary from the rate prevailing when the request is submitted.
I/we also understand that the rate communicated to us (if any) is an indicative rate and the actual rate may be different from the same.

FEMA DECLARATION
(Under Section10 (5), Chapter III of The Foreign Exchange Management Act, 1999)

I/We hereby declare that the transaction, the details of which are specifically mentioned in this letter does not involve, and is not designed for the purpose
of any contravention or evasion of the provisions of the aforesaid act of any rule, regulation, notification, direction or order made there under. I/ We 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/We also undertake that if I/ We 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.
I/We further declare that the undersigned has/have the authority to give the above debit authority, declaration and undertaking on behalf of the
firm/company.

Place

Date DD M M Y Y Y Y
(Authorised Signatory with Company/Firm seal)
Annexure I : Documents enclosed (please tick all that are relevant)

Self Attested copy of Commercial Invoice

Transportation Document (self Attested copy of Airway Bill/Bill of Lading/Courier receipt)

Triplicate Exchange Control copy of Bill of Entry in original/ Copy of Bill of Entry( in case of IDPMS)/ Courier wrapper/
Postal Appraisal Form/ Custom Assessment Certificate/ CA certificate (in case of Service Export/Import)

Supportive documents in case of delayed payment

Other documents

Enclose necessary supporting documents as per Annexure-1. Page 3/3

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