STANDING SETTLEMENT INSTRUCTIONS

FOR FOREIGN INWARD REMITTANCE(on customer's letterhead)

Account Information
Account number
(in 12 digits)
Customer Name
Phone Number
Email Id (Required for credit advice)

Credit Details
Currency Type

All Currency Type

Others(Please Specify)

Credit Amount

All Amounts
Amount Less than(Please Specify)
Amount Greater than(Please Specify)

Purpose of Remittance
Purpose of Remittance

Conversion Instruction
Account Type
INR
EEFC

Account Number

Percentage of Amount

I hereby authorize ICICI Bank Limited to process all future foreign inward remittances to the
above mentioned account as per these instructions.
The above instructions will remain valid for all future inward remittances till the ICICI Bank
Limited receives written contrary instructions from us signed by our Authorized Signatories.
We declare and undertake that foreign inward remittance received by us are not designed to
contravene or evade the provisions of the Foreign Exchange Management Act, 1999 (the
FEMA) or any of the Rules or Regulations made or Notifications or directions or orders issued
under the Act. We shall ensure compliance with all FEMA related reporting (if any) to RBI with
regard to all the foreign inward remittances received in our above account. We undertake that
the funds received through above foreign inward remittance will be used for the purpose as
declared above.

Name and signature of Authorized Signatories

Stamp of Company
Date:
Place: