1.

The application should be completed and submitted to the Chief General Manager, Exchange Control Department (Foreign Accounts Section),Reserve Bank of India, Central Office, Mumbai - 400 001, within three months from the date of the applicants arrival in India. If there is any delay in making the application, please explain the reasons therefor in a covering letter.

2.

This form should also be completed and submitted at the same address by Indian residents acquiring foreign currency assets by way of inheritance, gift, etc.

3.

Wherever codes have been provided, please write the appropriate code number against the relative item in the form.

4.

Authenticated copy of the purchase deed, lease agreement or such other documents relating to the purchase/acquisition of the property declared in this form should be attached.

5.

Foreign currency shares/securities/life insurance policies/immovable property held abroad should not be disposed of or dealt with in any manner whatsoever, without obtaining prior permission of the Reserve Bank.

6.

Please do not operate your overseas Foreign Currency Account(s) (including fixed/term deposits) without obtaining prior permission of the Reserve Bank, except for credit of dues and debit of bank charges, if any, and for remittances to India through normal banking channels.

1.

Type of form submitted

(Foreign Currency Accounts) Appendix I

(Foreign Currency Shares/ Securities) Appendix II

(Foreign Currency Insurance Policies) Appendix III

(Immovable Property situated outside India) Appendix IV

2.

Full Name of the Applicant

Surname

Firstname

Middlename

3.

Address of the Applicant

House No./Name

Locality/Road

Village/City

State

Country

Pincode

4.

(a)

Date of arrival in India

4.

(a)

(b)

Purpose of your return to India

(b)

5.

Nationality

6.

Country of origin

7.

Country of Residence (while abroad)

8.

Total Period of stay abroad

No. of years

No. of months

9.

Purpose of your stay and nature of your employment/ profession/business in each country in which you were residing before returning to India.

Country

Purpose

Nature of Employment/Profession/ business

Duration

10.

a)Whether you were sent abroad on deputation by your employers in India (yes/No)

10.(a)

 b)Name of the employer in India if the answer is yes

  (b)

 11.

Details of NRE/FCNR Accounts, if any

Name and address of the bank branch

Account No.

Whether the account has been redesignated as resident Rupee account, if so, documentary evidence may be submitted

12.

Remarks

Place:

(Signature of the Applicant)

Date :

Sr.

Name and address(es)

Country

Type of

Account No.

Date of

Whether held

No.

of the banks/

where

account

Opening

singly/ jointly

institution(s) with

account

(code)

which account/s is/

is

are to be maintained

maintained

1

2

3

4

5

6

7

1

2

3

If held Jointly

Balance at the

Purpose

Date of

Source

Name of joint

Relationship

whether

time of arrival

for which

maturity

of

holder

resident

in India

account is

of

funds

or non-

Currency

Amount

desired to

account,

resident

be

if any

maintained

(code)

8A

8B

8C

9

10

11

12

1.

2.

3.

Type of account code (column 4)

Purpose code (Column 10)

1.

Savings Account

1.

To receive dues from abroad

2.

Fixed deposit account

2.

To receive pension from abroad

3.

Current account

3.

To settle outstanding bills/

4.

Money market account

taxes/other liabilities etc.

5.

IRA Account

(please specify)

6.

Checking account

4.

To retain upto the date of

 7.

Others (Please specify)

maturity of FD/IRA account

5.

To receive dividend/interest

on shares/securities

6.

To receive grants

7.

Others (Please specify)

Place:

(Signature of the Applicant)

Date :

Sr.

Description

Country

Distinctive

No. of

Total Face

Appro-

Date

No.

of shares/

where

No.

shares/

Value

ximate

of

securities

shares

securities

market

purchase

are

Value

held

Currency

Amount

1

2

3

4

5

6

7

8

1.

2.

3.

Place:

(Signature of the Applicant)

Date :

Sr.

Name and

Country

 Type

Distinctive

Date of

Date of

Sum assured

No.

Address

where

of

No.

Commencement

maturity

of the

policy

Policy

Currency

Amount

Insurance

held

(Code)

Company

1

2

3

4

5

6

7

8

1.

2.

3.

Amount of

Date upto

Whether

Last date

Name & Address

Name of the

premium

which

policy

upto which

of the bank

beneficiary and

payable

premium

still in

premium

through whom

his/her

paid

force

payable

premium has to

residential

Amount

Period

(Yes/No)

be remitted

status

9

10

11

12

13

14

1.

2.

3.

Place:

(Signature of the Applicant)

Date :

Sr.

Description

Location

Country

Purpose

Property

Date of

Purchase Price

No.

of the

where

of

acquired

purchase/

Immovable

property

holding

by

lease

Currency

Amount

Property

held

the

(Code)

property

1

2

3

4

5

6

7

8

1.

2.

3.

Source

RBI

Approxi-

If property acquired

If property leased/rented

of

Approval,

mate

on lease

funds

if any

current

market

Period

Monthly/

Source

Period

Monthly/

How income

value

of

annual

of funds

of

annual

is being

lease

rent

lease

rent

utilised

payable

receivable

9

10

11

12A

12B

12C

13A

13B

13C

1.

2.

3.

Monthly annual

Whether the

If encumbered

Schedule of

expenses on

property is

repayment of loan

maintenance

free or

encumbered

Amount of loan

Name & Address

Amount

Instalment

of the lender

Quarterly/

Currency

Amount

Annual

14

15

16

17

1.

2.

3.

Place:

Date :

(Signature of the Applicant)