Statement showing drawals, utilisation, repayments and out standings of short-term foreign currency loan/credit for the month ended...........

Instructions

This statement should be completed, in duplicate, and one copy submitted by the borrower to the Chief General Manager, Exchange Control Department, Central Office , Reserve Bank of India, Mumbai 400 001, duly certified by an authorised dealer and the other copy to the concerned Regional Office of Exchange Control Department, Reserve Bank of India. The details of actual utilisation of the loan/credit should be furnished by way of an annexure in the attached form together with a complete set of documents evidencing utilisation of loan/credit viz. Exchange Control copy of Bill of Entry for Home Consumption, import licence (where the import is against a licence) and original commercial invoice.

1.

(i)

RBI Registration Number

(ii)

Amount of loan/credit approved

:

Currency

[For RBI use]

Amount______________________________

2.

Name and address of Borrower

:

_____________________________________

_____________________________________

(For RBI use)

_____________________________________

_____________________________________

3.

Country of lender

:

________________

(For RBI use)

4.

Amount outstanding as at the

:

________________

beginning of the month

(For RBI use)

Amount______________________________

5.

Drawdown Transaction during the month -

No.

Date of drawal

Currency

Amount

Balance Amount yet to be drawn at the end of the month

6.

Utilisation during the month -

No.

Date

Particulars of imports @

Country

Amount utilised

Balance Amount yet to be utilised at the end of the month

@ Capital goods/raw material/others

7.

Remittance during the month - (Debt Servicing)

No.

Purpose

Date of remittance

Currency

Amount

Country to which sent

1

Principal

(a)

(b)

(c)

2

Interest

(a)

(b)

(c)

8.

Name and Code of Authorised

:

:

_____________________________________

Dealer through which remitted

9.

Amount of loan/credit outstanding

:

Currency________

at the end of the month

[For RBI use]

:

Amount _____________________________

10.

Import documents submitted in

:

:

_____________________________________

the month of

We hereby certify that the particulars given above are true and correct to the best of our knowledge and belief

Place:___________

________________________________

Stamp

(Signature of Authorised Signatory)

Date :___________

Name ___________________________

Designation ______________________

[For use of Authorised Dealer]

This is to certify that the particulars furnished in the application have been scrutinised by

us and found to be correct.

Place:

………………………………………….

Date :

Stamp

(Signature of Authorised Signatory)

Name ....................................................

Designation ..........................................

Name of bank/branch ...................……...

ANNEXURE TOECB5

Details of utilisation of short-term foreign currency loan/credit

[This should be submitted withECB5 with a complete set of documentary evidence in support of utilisation of loan/credit, till such time the loan/credit has been fully utilised and all the relative documents submitted to RBI]

Report for the month ended ..............

1.

Name of the borrower

:

FCL Registration No.

:

We state that we were permitted to raise a foreign currency loan/credit for _____________ (amount)

from____________________________ for the purpose of______________________

We hereby certify that the amount of loan/credit has been utilised by us fully/partly for the

approved purpose strictly in accordance with the terms and conditions of the loan approved by Reserve Bank of India

The details of utilisation are as under.

:

(a)

Description of goods imported

-

(b)

Value of imports

-

(c)

Documentary evidence in support of above imports (Enclose the following documents)

-

i)

Original Invoice No. & date

-

ii)

EC copy of Bill of entry for Home Consumption (No. & date)

-

iii)

EC copy of import licence, if any, No. & date

-

iv)

Others (specify)

-

We certify that the information furnished above is true and correct. No material

information which may affect the RBI decision to allow the remittances connected with this loan/credit, has been withheld by us.

________________________________

(Signature of Authorised Signatory)

Place:____________

Name: ___________________________

Date :___________

Designation: _____________________.

Full Address: _____________________

_____________________

_____________________

We hereby certify that the foreign currency loan/credit permitted to be raised by RBI

vide its letter No.______________________ dated____________ and Registration No. _______ has been raised by ______________________________ and utilised by the said (Name of the borrower) borrower for the declared purpose of ________________________________

We have verified all the relevant documents and our record connected with the utilisation

of loan/credit and found these to be in order in accordance with the terms and conditions of approval granted by RBI as also the provision of Exchange Control Manual, 1993 edition and to our satisfaction. We hereby certify that the foreign currency loan/credit permitted to be raised by RBI.

________________________________

(Signature of Authorised Official)

Place:____________

Date :___________

Stamp

Designation: _____________________.

Address: _____________________