1.

The application should be completed in duplicate and submitted through an authorised dealer from whom the applicant desires to avail of the loan/overdraft.

2.

Suitable documentary evidence in support of the purpose of the loan.

1.

Name, nationality and address of borrower

2.

(i)

Nature of employment/profession/ occupation/business in India

(i)

(ii)

Number & date of Reserve Banks approval

(ii)

3

Amount of loan/overdraft

4.

Details of securities pledged or guarantee given

5.

Purpose of loan/overdraft

6.

Period for which loan/overdraft is required

7.

Source of funds from which loan/overdraft will be liquidated

8.

Length of time since when facility has been in existence

9

Details of similar facilities availed of by other members of the family of the borrower from the bank through which this application is routed

10.

Details of similar facilities availed of by the borrower and members of his family with any other authorised dealer in foreign exchange

11.

Any other relevant information

I hereby declare that the particulars given above are true and correct to the best of my

knowledge and belief.

Place

:

.............................

.............................................

Date

:

.............................

(Signature of Borrower)

Certified that the application and documents submitted are in order. We recommend that

the facility applied for may be approved by Reserve Bank.

...........................................................................

Stamp

(Signature of Applicant/Authorised Official)

Name:

................................................................

Designation:

.......................................................

Date :

....................

Name and Address

.............................................

of Authorised Dealer

..........................................