PAYMENT INSTRUCTIONS

You’re nearly there!

To help us make sure your payment arrives at your Institution on time and in full, please complete your transfer as soon as possible
using the instructions below.

These instructions are valid until 27/11/2020 05:01:22 EST

*You cannot use this payment instruction after this date. If the date above has passed, go online again and create a new quote. Note that
there will be a small processing fee charged by ICICI Bank.

Due to Indian regulations, in order to complete your payment you will need to present the attached Retail Outward Remittance
Application – A2 cum LRS Declaration along with proof of identity and address at a local ICICI Bank branch. You must also present
your PAN CARD. If you do not, ICICI Bank will not be able to complete your transaction.
To find the nearest ICICI Bank branch, please use their branch locator by clicking here.

PAYMENT INSTRUCTIONS
1. Print the Retail Outward Remittance Application – A2 cum LRS Declaration and payment instructions forms
2. Fill out the Retail Outward Remittance Application – A2 cum LRS Declaration. Note that much of the information has been
pre-populated for your convenience. Below are the items which are to be completed by the person making the INR payment
(Remitter).
It is important that all items below are completed in full to ensure efficient processing of your payment.
Section I: The remitter fills in their name, address and phone number.
Section II.b: F
 ill in the designated amount of INR shown on the attached instructions in words. Ensure that the amount
populated in numbers as well.
Section III: ICICI account holders only - The remitter provides the ICICI INR account number to be debited for the
payment. (Non-ICICI account holders see item 4 below)
Section V: Provide the Student Name, Student ID and Country of Study Abroad.
Section VI: Please ensure that the ICICI representative includes the displayed reference number with the wire payment.
Signature: T
 he remitter signs and dates the Retail Outward Remittance Application – A2 cum LRS Declaration at the end of
the declaration on page 3.
3. Non-ICICI account holders must transfer funds locally from their respective bank accounts to ICICI Bank pool account
through NEFT/RTGS as per the details mentioned below:
• Beneficiary Name: Outward Remittance Pool Account
• Account Number: 0035SLORCBPC
• IFSC Code: ICIC0000035
4. Take the printed/signed documents and present your proof of identify and address for verification by ICICI Bank. The ICICI
representative will complete the KYC Certification with the remitter as applicable. Acceptable identification includes:

Proof of Identity Proof of Address

PAN Card Photo Ration Card Passport Certificate/ID Card/Savings Pass Book Issued by Post Office

Voter ID Card Senior Citizen Card Telephone Bill Latest premium receipt of any life insurance co.

Driving License Passport Electricity Bill Consumer gas connection card/book/pipe gas bill

Government ID Card Bank Statement with Cheque Leave/Lease and License Agreement

5. ICICI Bank will process your request. Western Union Business Solutions will then deliver your payment to your Institution to
complete the payment.

Need help
If you have questions relating to this transfer, contact Western Union Business Solutions:
e: [email protected]

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256561547-2018-09
 Retail Outward Remittance Application – A2 Cum LRS Declaration

Track Number Originating Br. ID Scan Br. ID AD Code

For Office Use Only

Additional Information
(if any)

(To be completed by the applicant in block letters using black ink pen)
Application for drawal of Foreign Exchange

I. Details of the Applicant (Remitter)

a. Name of the Applicant

b. Address (Not mandatory

for ICICI A/c holders)

c. Applicant Phone No. d. PAN No.*

(* PAN no. is mandatory for all resident customers)
II. Details of Foreign Exchange required (Fill-up either II a or II b) (Ref Annex-III for applicable Currency Details)
II a. For remittance of fixed amount of Foreign Currency
Foreign Currency CAD FC
Amount
FC Amt in figures In Words
(OR) II b. For remittance in Foreign Currency equivalent to Fixed Rupee Amount
Foreign Currency INR
Amount
INR Amt in figures 993,424.00 In Words
II c. Purpose of Remittance with Remittance Scheme and Purpose Code
(Please tick (√) against the purpose code in Annexure – I)
Whether under LRS (Yes/No) Purpose Code Purpose Description

II d. Name of the country providing ultimate services:

(in case payment is for import of services for below Purpose Groups)____________________________________________________
02 (Transport) 09 (Charges for the use of intellectual property)
03 (Travel) 10 (Other Business Services)
05 (Construction Services) 11 (Personal, Cultural & Recreational services)
06 (Insurance and Pension Services) 15 (Others)
07 (financial Services) 16 (Maintenance and repair services)
08 (Telecommunication, Computer & Information Services) 17 (Manufacturing services (goods for processing))

III. I / We authorize you to debit my / our below Account together with your charges* III a. Please issue
Telegraphic Transfer Demand Draft
OR
TT DD
*For ICICI Bank charges please refer our website www.icicibank.com
IV. Beneficiary Name

W E S T E R N U N I O N B U S I N E S S
S O L U T I O N S
IV a. Beneficiary Address
1 2 A P P O L D S T R E E T
L O N D O N E C 2 A 2 A W
 Retail Outward Remittance Application – A2 Cum LRS Declaration

IV b. Beneficiary A/c Number (Incase of TT)

IV c. Name of the Bank where the beneficiary A/c is maintained (In case of TT)

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

IV e. Beneficiary Bank address including Country at which the beneficiary maintains A/c (mandatory in case of TT in CAD, QAR
& JPY Currencies)

IV f. Furnish the following details of CORRESPONDENT BANK if the Foreign Currency is sent to a Country other than the home
Country of the Currency (Eg. Remitting GBP currency to a beneficiary residing in Australia)
SWIFT CODE CORRESPONDENT BANK NAME

V a. If the purpose selected is one of the below then it is mandatory to furnish the details sought for
Maintenance Relationship of beneficiary (Ref Table
below)
Purchase of Immovable
The location of property being Country____________________________________
Property
purchased (Country / State) State_______________________________________
Education Student Name and Student ID (if
any). Country of study abroad
Gift Residential status of beneficiary
(Resident/NRI/Foreign National)
Emigration I/We hereby confirm that remittance request is to meet the incidental expenses in the country of
(Please check to agree) emigration and not for undertaking any capital account transactions such as overseas investment
in government bonds; land; commercial enterprise; etc.
Investment abroad 1. Equity Shares* *In Case of Shares Please Specify
(Select the nature of Name of Company
2. Mutual Funds
investment)
3. Venture Capital Fund Listed / Unlisted (Please indicate)
4. Debt Security*
Stock Exchange Where Listed
5. Promissory Notes
6. Others (Specify) Country of Incorporation

Type of Company (eg LLP, Ltd)

Number of equity shares to be acquired

Percentage of equity shares being acquired (Less Than

5% in overseas entity OR Equal to or greater than 5% in
the overseas entity.
 Retail Outward Remittance Application – A2 Cum LRS Declaration
Will investment be subscribed to the Memorandum of
Assocoation of the overseas entity (Yes/No)

Whether any other financial commitments such as

investment in Optionally Convertible Preference Shares,
Loan, Guarantee, etc in the overseas entity will be
undertaken (Yes/ NO)

Investment is made in existing entity and already

incorporated by others (Yes/NO):

Remitter Beneficiary relationship (Investor/Other, Please

specify)

*In Case of Debt Security Please Specify

Name of the issuing company

Investment Type

Name of the Instrument

Listed / Unlisted (Please indicate)

Stock Exchange Where Listed

List of close relatives (‘relative’ as defined in Section 2(77) of the Companies Act, 2013)
Father (including Step Father) Son’s wife Member of HUF Husband (or) Wife
Mother (including Step Mother) Daughter Daughter’s Husband Sister (Including Step Sister)
Brother (including step Brother) Son (Including step Son)

VI. Furnish below if a message to be sent along with wire transfer on your behalf
ECAAB33273181530
…………………………………….………………………………………………………………………………
VII. Source of Funds (only for transfer from NRO accounts)
Sl No Source of Funds Amount (INR)

Please add a separate sheet for more Sources of Funds to declare

VIII. Please tick (√) against the appropriate box

<- - - - - - - - - - - - - - - - - - Limit Category - - - - - - - - - - - - - - - - - - >

LRS NRO Others
Customer Category Net Salary No Limit
$ 250 K $ 1 Mio ( Mention the Limit in USD )

Resident Indian
NRI / PIO
a) NRE / FCNR A/c

b) NRO A/c of an NRI / PIO

Foreign National
a) Foreign Tourist

b) Employed in India

Trust / Association / Society / Club

Others

If Limit Category “Others” is chosen, then enclose necessary supporting documents.

 Retail Outward Remittance Application – A2 Cum LRS Declaration
Declaration (Under FEMA 1999)
 I/we hereby declare that the total amount of foreign exchange purchased from or remitted through all sources in India
during this financial year including this application is within overall limit of the Liberalised Remittance Scheme prescribed
by the Reserve Bank of India and certify that the source of funds for making the said remittance belongs to me and the
foreign exchange will not be used for prohibited purposes.
 The total amount of foreign exchange purchased from or remitted through, all sources in India during this financial year
including this application is within USD ________________________________________(USD __________________) the annual
limit prescribed by Reserve Bank of India for the said purpose.
 Foreign exchange purchased from you is for the purpose indicated above.
 The above remittance is NOT for investment / purchase of Bitcoin/Cryptocurrencies/Virtual Currencies (such as Ethereum,
Ripple, Litecoin, Dash, Peercoin, Dogecoin, Primecoin, Chinacoin, Ven, Bitcoin or any other virtual
currency/cryptocurrency/bitcoin).
 The above remittance is NOT for investment in units of mutual funds/shares or any other capital instrument of a company
dealing in Bitcoins/Cryptocurrency/Virtual Currencies.
 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 confirm that the aforesaid declarations and statements are true and correct to the best of my knowledge and belief.
 I/ We hereby declare that the transaction mentioned above doesn’t 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 read with
schedule I therefore of Viz,
1. Travel to Nepal & or Bhutan
2. Transaction with a person resident in Nepal or Bhutan
3. Remittance out of lottery winnings
4. Remittance of Income from Racing / riding etc. or any other hobby.
5. Remittance for purchases of Lottery tickets, banned or prescribed magazines, football pools, sweep stakes,
schemes involving money circulations, securing prize money awards etc.
6. Payment of commission on exports made towards equity investments in joint ventures / wholly owned subsidiaries
abroad of Indian Companies
7. Remittance of dividend by any company to which the requirement of dividend balancing is applicable.
8. Payment of commission on export under rupee state credit route except commission up to 10% in invoice value
of exports of Tea & Tobacco.
9. Payment related to “Call back services” or telephones.
10. Remittance of interest income on funds held in non-resident special rupee a/c schemes.
 I / We, being a person(s) resident outside India, hereby declare that under Sec 4(b) of FEMA Permissible Capital A/c
Transaction regulation, 2000, the transaction mentioned above doesn’t involve and is not designed for any repatriation
outside India out of the proceeds of any investment in India, in any form, in any Company, Partnership firm (or) Proprietary
concern or any entity, whether incorporated or not, which is engaged or proposes to engage
a. In the business of chit funds or
b. As Nidhi company or
c. In agricultural or plantation activity, or
d. In real estate business, or construction of farm houses (real estate business shall not include development of townships
construction of residential / commercial premises roads or bridges), or
e. In trading and transferable development rights (TDRs)
 I / We being a person(s) resident outside India, hereby declare that no portion / part of outward remittance represents
interest on refunds of funds received from outside India for purchase of shares in India. Updated list of prohibited
transactions under FEMA can be accessed on ICICI Bank website (www.icicibank.com).
*(Strike out whichever is not applicable)
Other relevant declarations:
I/we hereby declare that the purpose and transaction details as mentioned above are true to the best of my knowledge does not
involve, and is not designed for the purpose of any contravention or evasion of the provisions of the FEMA, 1999 or any rule,
regulation, notification, direction or order made there under. I/We agree that I/We shall be responsible and liable for any incorrect
detail provided by me/us.
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 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 ICICI
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 ICICI account. I/we further agree that once the
funds remitted by me/us have been transmitted by ICICI bank to the correspondent and/or beneficiary banks, ICICI bank 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
ICICI Bank, intermediary Bank charges may be levied by Correspondent and / or Beneficiary Banks, which may vary from bank
to bank.
 Retail Outward Remittance Application – A2 Cum LRS Declaration
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 ICICI
bank 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.
I / We authorize you to remit outwardly as per details provided in the application.

To be filled in by residents only if the remittance is made under LRS

To be filled in by residents
Declaration only if the
for purchase remittance
of Foreign is made
Exchange under LRS
under
the Liberalised Remittance Scheme (LRS) of USD 250,000 for Resident Individuals
Mandatory details to be provided for remittance under LRS
Source of funds for remittance under LRS

Details of the remittances made/transactions effected under the Liberalised Remittance Scheme in the current financial year
(April- March) ………….
SN Date Amount Name and Address of AD Branch / FFMC through which the transaction has been effected
1
2
3

I / We hereby declare that the total amount of Foreign Exchange purchased from (or) remitted abroad through all sources in
India during the financial year as given above, including utilization of the said limit on account of Loan extended or gift made
in Indian Rupees credited to NRO A/c of Non Resident Close relative(s), is within the limit of USD 250,000/- (US Dollar Two
Lakh Fifty Thousand Only), which is the limit prescribed by RBI for the purpose and certify that the source of funds for making
the said remittance belong to me and will not be used for prohibited purposes.
I / We, being a person(s) resident in India, hereby declare that for transactions done under the Liberalised Remittance Scheme
(LRS) for resident individuals, issued and amended by RBI from time to time, is not in the nature of remittance for margin calls
to overseas exchanges / overseas counter parties under this scheme.
Please tick the check-box if the remittance is made under purpose of Investment in shares
(Applicable for residents only)
I / We accordingly confirm as under:
This 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 Liberalised Remittance Scheme for resident Individuals.
That the investment is in the shares of an existing company and is not intended to create a Joint Venture or Wholly-Owned
Subsidiary outside India*.
I/we also confirm that the remittance is towards purchase of shares of a foreign company and not in the shares of an Indian
company
*Incase your investment is into Joint Venture or Wholly Owned Subsidiary outside India, please inform the Bank official
accordingly.”
..........................................................
Signature of Remitter / Guardian in case of Minor

.......................................................................................
Date ………………….… Signature of Remitter / POA (or) Mandate Holder / Guardian in case of Minor
(The signature by mandate holder will be accepted only for Non resident A/c holders where mandate is duly registered with the Bank )

I certify that I have verified the Customer’s signature as per Bank records and retained the originals of all the scanned
documents and forms submitted by the remitter for the above transaction.
I also certify that in case of LRS 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.

Name & Employee ID Date & Place Bank Stamp & Employee Signature
………………………………………………………………………………………………………………………………………….
 Retail Outward Remittance Application – A2 Cum LRS Declaration
AD / Branch Official should put a tick against appropriate purpose code Annexure - I
PURPOSE PURPOSE CODE DESCRIPTION FOR REPORTING UNDER FETERS
CODE
Capital Account
Acquisition of non-produced non-financial assets (Purchase of intangible assets like patents, copyrights, trademarks etc., land
S0017
acquired by government, use of natural resources) – Government
Acquisition of non-produced non-financial assets (Purchase of intangible assets like patents, copyrights, trademarks etc., use of
S0019
natural resources) – Non-Government
Capital transfers ( Guarantees payments, Investment Grand given by the government/international organization, exceptionally
S0026
large Non-life insurance claims) – Government
Capital transfers ( Guarantees payments, Investment Grand given by the Non-government, exceptionally large Non-life
S0027
insurance claims) – Non-Government
S0099 Other capital payments not included elsewhere
Foreign Direct Investment
S0003 Indian Direct Investment abroad (In Branches and wholly owned Subsidiaries)
S0004 Indian Direct investment abroad (in subsidiaries and associates) in debt instruments
S0005 Indian investment abroad – in real estate
S0006 Repatriation of Foreign Direct Investment made by overseas Investors in India – in equity shares
S0007 Repatriation of Foreign Direct Investment in made by overseas Investors India – in debt instruments
S0008 Repatriation of Foreign Direct Investment made by overseas Investors in India – in real estate
Foreign Portfolio Investments
S0001 Indian Portfolio investment abroad – in equity shares
S0002 Indian Portfolio investment abroad – in debt instruments
S0009 Repatriation of Foreign Portfolio Investment made by overseas Investors in India – in equity shares
S0010 Repatriation of Foreign Portfolio Investment made by overseas Investors in India – in debt instruments
External Commercial Borrowings
S0011 Loans extended to Non-Residents
S0012 Repayment of long & medium term loans with original maturity above one year received from Non-Residents
Short Term Loans
S0013 Repayment of short term loans with original maturity up to one year received from Non-Residents
Banking Capital
S0014 Repatriation of Non-Resident Deposits (FCNR(B)/NR(E)RA)
S0015 Repayment of loans & overdrafts taken by ADs on their own account.
S0016 Sale of a foreign currency against another foreign currency
Financial derivatives and others
S0020 Payments made on A/c of margin payments, premium payment and settlement amt etc. under Financial derivative transactions.
S0021 Payments made on account of sale of share under Employee stock option
S0022 Investment in Indian Depositories Receipts (IDRs)
S0023 Opening of foreign currency account abroad with a bank
External Assistance
S0024 External Assistance extended by India. e.g. Loans and advances extended by India to Foreign Govt. under various agreements
S0025 Repayments made on account of External Assistance received by India.
Imports
S0101 Advance payment against imports made to countries other than Nepal and Bhutan
S0102 Payment towards imports- settlement of invoice other than Nepal and Bhutan
S0103 Imports by diplomatic missions other than Nepal and Bhutan
S0104 Intermediary trade/transit trade, i.e., third country export passing through India
S0108 Goods acquired under merchanting / Payment against import leg of merchanting trade*
S0109 Payments made for Imports from Nepal and Bhutan, if any
Transport
S0201 Payments for surplus freight/passenger fare by foreign shipping companies operating in India
S0202 Payment for operating expenses of Indian shipping companies operating abroad
S0203 Freight on imports – Shipping companies
S0204 Freight on exports – Shipping companies
S0205 Operational leasing/Rental of Vessels (with crew) –Shipping companies
S0206 Booking of passages abroad – Shipping companies
S0207 Payments for surplus freight/passenger fare by foreign Airlines companies operating in India
S0208 Operating expenses of Indian Airlines companies operating abroad
S0209 Freight on imports – Airlines companies
S0210 Freight on exports – Airlines companies
S0211 Operational leasing / Rental of Vessels (with crew) – Airline companies
S0212 Booking of passages abroad – Airlines companies
 Retail Outward Remittance Application – A2 Cum LRS Declaration
S0214 Payments on account of stevedoring, demurrage, port handling charges etc.(Shipping companies)
S0215 Payments on account of stevedoring, demurrage, port handling charges, etc.(Airlines companies)
S0216 Payments for Passenger - Shipping companies
S0217 Other payments by Shipping companies
S0218 Payments for Passenger - Airlines companies
S0219 Other Payments by Airlines companies
Payments on A/c of freight under other modes of transport (Internal Waterways, Roadways, Railways, Pipeline transports and
S0220
others)
Payments on account of passenger fare under other modes of transport (Internal Waterways, Roadways, Railways, Pipeline
S0221
transports and others)
S0222 Postal & Courier services by Air
S0223 Postal & Courier services by Sea
S0224 Postal & Courier services by others
Travel
S0301 Business travel.
S0303 Travel for pilgrimage
S0304 Travel for medical treatment
S0305 Travel for education (including fees, hostel expenses etc.)
S0306 Other travel (including holiday trips and payments for settling international credit cards transactions)
Construction Services
S0501 Construction of projects abroad by Indian companies including import of goods at project site abroad
S0502 Cost of construction etc. of projects executed by foreign companies in India.
Insurance and Pension Services
S0601 Life Insurance premium except term insurance
S0602 Freight insurance – relating to import & export of goods
S0603 Other general insurance premium including reinsurance premium; and term life insurance premium
S0605 Auxiliary services including commission on insurance
S0607 Insurance claim Settlement of non-life insurance; and life insurance (only term insurance)
S0608 Life Insurance Claim Settlements
S0609 Standardized guarantee services
S0610 Premium for pension funds
S0611 Periodic pension entitlements e.g. monthly quarterly or yearly payments of pension amounts by Indian Pension Fund Companies.
S0612 Invoking of standardized guarantees
Financial Services
S0701 Financial intermediation, except investment banking - Bank charges, collection charges, LC charges etc.
S0702 Investment banking – brokerage, under writing commission etc.
S0703 Auxiliary services – charges on operation & regulatory fees, custodial services, depository services etc.
Telecommunication, Computer & Information Services
S0801 Hardware consultancy/implementation
S0802 Software consultancy / implementation
S0803 Data base, data processing charges
S0804 Repair and maintenance of computer and software
S0805 News agency services
S0806 Other information services- Subscription to newspapers, periodicals
S0807 Off-site software imports
S0808 Telecommunication services including electronic mail services and voice mail services
S0809 Satellite services including space shuttle and rockets etc.
Charges for the use of intellectual property n.i.e
S0901 Franchises services
Payment for use, through licensing arrangements, of produced originals or prototypes (such as manuscripts and films), patents,
S0902
copyrights, trademarks and industrial processes etc.
Other Business Services
S1002 Trade related services – commission on exports / imports
S1003 Operational leasing services (other than financial leasing) without operating crew, including charter hire- Airlines companies
S1004 Legal services
S1005 Accounting, auditing, book-keeping services
S1006 Business and management consultancy and public relations services
S1007 Advertising, trade fair service
S1008 Research & Development services
S1009 Architectural services
S1010 Agricultural services like protection against insects & disease, increasing of harvest yields, forestry services.
 Retail Outward Remittance Application – A2 Cum LRS Declaration
S1011 Payments for maintenance of offices abroad
S1013 Environmental Services
S1014 Engineering Services
S1015 Tax consulting services
S1016 Market research and public opinion polling service
S1017 Publishing and printing services
S1018 Mining services like on–site processing services analysis of ores etc.
S1020 Commission agent services
S1021 Wholesale and retailing trade services.
S1022 Operational leasing services (other than financial leasing) without operating crew, including charter hire- Shipping companies
S1023 Other Technical Services including scientific/space services.
S1099 Other services not included elsewhere
Personal, Cultural & Recreational Services
S1101 Audio-visual and related services like Motion picture and video tape production, distribution and projection services.
S1103 Radio and television production, distribution and transmission services
S1104 Entertainment services
S1105 Museums, library and archival services
S1106 Recreation and sporting activities services
S1107 Education (e.g. fees for correspondence courses abroad )
Health Service (payment towards services received from hospitals, doctors, nurses, paramedical and similar services etc.
S1108
rendered remotely or on-site)
S1109 Other Personal, Cultural & Recreational services
Government not included elsewhere (G.n.i.e.)
S1201 Maintenance of Indian embassies abroad
S1202 Remittances by foreign embassies in India
Secondary Income
S1301 Remittance for family maintenance and savings
S1302 Remittance towards personal gifts and donations
S1303 Remittance towards donations to religious and charitable institutions abroad
S1304 Remittance towards grants and donations to other governments and charitable institutions established by the governments.
S1305 Contributions/donations by the Government to international institutions
S1306 Remittance towards payment / refund of taxes.
S1307 Outflows on account of migrant transfers including personal effects
Primary Income
S1401 Compensation of employees
S1402 Remittance towards interest on Non-Resident deposits (FCNR(B)/NR(E)RA, etc.)
S1403 Remittance towards interest on loans from Non-Residents (ST/MT/LT loans) eg. External Comm. Borrowings, Trade Credits, etc.
S1405 Remittance towards interest payment by ADs on their own account (to VOSTRO a/c holders or the OD on NOSTRO a/c.)
S1408 Remittance of profit by FDI enterprises in India (by branches of foreign companies including bank branches)
S1409 Remittance of dividends by FDI enterprises in India (other than branches) on equity and investment fund shares
S1410 Payment of interest by FDI enterprises in India to their Parent company abroad.
S1411 Remittance of interest income on account of Portfolio Investment in India
S1412 Remittance of dividends on account of Portfolio Investment in India on equity and investment fund shares
Others
S1501 Refunds / rebates / reduction in invoice value on account of exports
S1502 Reversal of wrong entries, refunds of amount remitted for non-exports
S1503 Payments by residents for international bidding
Notional sales when export bills negotiated/ purchased/ discounted are dishonored/ crystallized/ cancelled and reversed from
S1504
suspense account
S1505 Deemed Imports (exports between SEZ, EPZs and Domestic tariff areas)
Maintenance and repair services n.i.e
S1601 Payments on account of maintenance and repair services rendered for Vessels, ships, boats, warships, etc.
Payments on account of maintenance and repair services rendered for aircrafts, space shuttles, rockets, military aircrafts,
S1602
helicopters, etc.
Manufacturing services (Goods and Processing)
S1701 Payments for processing of goods
 Retail Outward Remittance Application – A2 Cum LRS Declaration
(For Office Use Only)
Annexure-II
KYC Certification

(To be filled and scanned only in case of remittance by non ICICI Customer)

I confirm having met Mr./Ms./Mrs. _______________________________ at the Branch / other location (specify)

Further, I confirm having verified the copies of below KYC documents (as applicable) with the originals produced by the applicant and that the
applicant has signed the documents in my presence.

ID Proof

Address Proof

Name of the Bank official __________________________________________________________ Employee No. ____________ Designation __________

Date : _______________ Signature of the Branch Official and Branch stamp

Name of BM / BOM authorizing KYC certification above _________________________________________________ Employee No. ________________

Date : ______________ Signature of the Branch Official and Branch stamp

Details of INR amount credited to the pool a/c (Incl. of Charges + GST) _________________________________________________________________

Finacle Tran ID. ___________________________________________ IBR No. ________________________________________________________________

Date of credit _____________________________________________ into Pool A/c No.0035SLORCBPC

(If the remittance is by way of accepting cash deposit then the amount should not exceed INR 50,000/-)

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List of Approved Currencies for sending TT (or) DD Annexure-III

CURRENCY TT DD CURRENCY TT DD CURRENCY TT DD

US Dollar (USD)   Hong Kong Dollar (HKD)   Saudi Arabian Riyal (SAR)  
Great Britain Pounds (GBP)   New Zealand Dollar (NZD)   Qatari Riyal (QAR)  
Euro (EUR)   Japanese Yen (JPY)   Arab Emirates Dirham (AED)  
Canadian Dollar (CAD)   Swiss Francs (CHF)   Danish Kroner (DKK)  
Australian Dollar (AUD)   Swedish Kroner (SEK)   Norwegian Kroner (NOK)  
Singapore Dollar (SGD)    

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