Name of the Authorised Dealer

:

____________________________

AD Code No._______________

Full address

:

____________________________

____________________________

Fax No.

:

____________________________

(in equivalent U.S.$(thousands)*

Sr.
No.

Name of the Indian Company

Date of Approval

JV or WOS

RBI Identification No.**

Country of location

Line of activity

Amount of equity approved

Amount of equity remitted

Date

Amount

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

Amount of loan approved

Amount of loan remitted

Amount of guarantee approved

Amount remitted under invoked guarantee

Date

Amount

Date

Amount***

(11)

(12)

(13)

(14)

(15)

(16)

(Signature of Authorised Official)

Place:__________

Stamp/Seal

Name : ___________________________

Date :__________

Designation : ______________________

*

Where the investment is in a currency other than U.S.$, the spot cross currency rate on the date of remittance should be applied for conversion into U.S.$

**

Unique Identification (Approval)No. of RBI in respect of existing JV/WOS already approved by Govt. of India/RBI should be indicated here. In respect of supplementary proposals where the original investment was sanctioned by the authorised dealer under the EEFC, Fast Track Route, the Identification No.communicated to them by RBI has to be quoted.

***

Where any amount, over and above the balances available in the EEFC account, has been purchased from the market to meet the obligations, the same should be indicated within brackets.