A.D. code No.

6360180-8000009
Form No.A1/__________/20__
(to be filled by Authorised Dealer)
FORM A-1 Serial No.___________________
(For Import Payments only) (for use of Reserve Bank of India)
(Application for Remittance in foreign Currency) Amount
remitted: CHF 98’246
Currency Amount
Equivalent of Rupees

(To be completed by Authorized Dealer)

__________________________________________________________________________________________________
I/we wish to purchase CHF NINETY EIGHT THOUSAND TWO HUNDRED AND FOURTY SIX
ONLY
(Name of Currency) (Amount in words)
Through AXIS BANK LTD., PATANCHERU BRANCH, HYDERABAD for payment to
(Name and address of the authorized dealer)

STRRAG AG, SWITZERLAND in payment of

(Name and address of the beneficiary of remittance)

Details of goods imported or to be imported into India

Imports into India,detailed below:
Section A: Import Licence / Open General Licence particulars
o.G.L._________ ______________ _______________
NUMBER PART SCHEDULE SERIAL NUMBER
Import Licence Date of Issue Date of Expiry Face Amount Balance
Prefixes Licence Suffixes Value of to be outstanding on
Year

Year
Date

Date
Month

Month
Licence endorse the licence after
1 2 1 2 3 4 5 d (in The remittance
Rs.) #

#Actual amount endorsed in rupees against each licence involved, should be stated under this column.
Note: If more than one licence is involved particulars of all licences should br furnished. If space is in-adequate, separate
statement may be attached. The amount utilized against each licence should invariably be indicated.

Section : B Import particulars

Invoice Details
Countr Mode of Date of
Count y from shipment shipment
Terms
Currency

BTN ry of which (Air, sea, if not

No. (c.i.f. Quantity Descriptio
Classifi origin goods post, rail, known
and f.o.b. Amount of goods n of goods
cation of are River then
date c & f) goods consign transport approxim
etc. ed etc.) ate date.
MILLING FIVE AXIS
MACHINES BLADE

LANDSWITZER

LANDSWITZER
8459.6110
CHF 98’246

3 SETS
CIP

CHF

SEA

Section : C Other particulars

1. Details of forward purchase contract, if any. _______________ ________________ _____________
(No. & date of contract) Currency and amount (Balance under)
of contract

2. If remittance to be made is less than invoice value, reasons ________________________________________

therefore (i.e. remittance, instalment etc.) ________________________________________

__________________________________________________________________________________________________
I/We hereby declare that the statements made by me/us on this form are true and that I/we have not applied for an
authorization through any other Bank.
I/We declare and also understand that the foreign exchange to be acquired by me/us pursuant to this application shall be
used by me/us only for the purpose for which it is acquired and that the conditions subject to which the exchange is
granted will be complied with. ________________________________________
Signature of Applicant / Authorized Official
(a) Name and Address of Applicant ____________

(b) Nationality ____________________________

Date: 02.08.2019____ Stamp (a) To be filled in capital letters
Note: For remittance covering intermediary trade, Form A2 should be used.

Declaration to be furnished by Applicant

I/We declare that
(a) that import licances against which the remittance is sought is/are valid and has/have not been
cancelled by the ITC Authorities.
(b) The goods to which this application relates have been * imported into India on my/our account.
will be *

(c) The import is on behalf # ______________________________________________________

(d) The invoice value of the goods which is declared on this form is the real value of the goods
Imported * into India.
To be Imported *
If the import I/we attach the relative Customs stamped Exchange Control copy of Bill of Entry *
Post parcel wrapper (for imports by post)
Or
If the import I/we undertake to produce within three months to the Authorized Dealer the relative
Custom Stamped Exchange / Post Parcel Wrapper

If the import Control Copy of Bill of Entry (For imports by post)

* Strike out item not applicable
# Where the import is on behalf of Central / State Government Department of a Company owned by
Central / State Government Statutory Corporation, Local Body etc. the name of the Government
Department Corporation etc. should be stated.

Date: 02.08.2019 Signature of the Applicant (Authorized Official)

_________________________________________________________________
___________
Space for Comments of the Authorized Dealer
(While forwarding the application to the Reserve Bank of India for approval, reference to Exchange Control
Manual paragraph / AD circular in terms of which the reference is made should invariably be cited. If any
remittance application on account of the same import was referred to the Reserve Bank earlier, reference
to the last correspondence / approval should also be cited.)

(Signature of Authorised Official)

Name :
Designation :
Name and Address of
Date : _____________ Stamp Authorised Dealer
____________________________________________________________________________
Certificate to be furnished by Authorised Dealer (Importers Banker)
We hereby certify that
(a) the payment is
Put a (i) an advance remittance
Tick(√) (ii) In retirement of bills under Letter of Credit opened through us.
In the (iii) against documents received through our medium of collection
Relevant (iv) on account of documents received direct by the applicant (s) against undertaking
Block furnished by the letter to submit Customs stamped Exchange Control copy of Bill of Entry
/Post parcel wrapper within three months.
(v) on account of documents received direct by the applicant (s) against Customs stamped
Exchange Control copy of Bill of Entry / post parcel wrapper (attached) submitted by the
Latter.
(vi) __________________________________________________________________
(any other case, to be explained)
(b) all the Exchange Control regulations applicable to the remittance have been complied with
(c) the payment made to the supplier of the goods has been * made through Chase,NY /
will be * Wachovia NY / Amex FFT
(Name and address of the foreign Bank)
We also certify / undertake that the relevant Customs-stamped Exchange Control copy of Bill of Entry or
post parcel wrapper
Ο shall be verified by us within three months (vide certificate (a) (ii) and (iii) above
Ο has been verified (vide certificate (a) (v) above
Ο shall be obtained from the applicant (s) within three months (vide certificate (a) (i) (iv)
Above

For
(Signature of Authorised Official)
Name: Axis BANK LTD.
Designation: 6-3-879/B
Name and Greenlands Road
Address of Begumpet
Authorised Hyderabad
Date: _________________ Stamp Dealer 500 016.
____________________________________________________________________________
Strike out item not applicable