Name of the Authorised Dealer

:

____________________________

Full address

:

____________________________

AD Code No._______________

____________________________

Fax No.

:

____________________________

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

Sr.
No.

Name of the Indian Company

JV or WOS

RBI Identifi-cation No.**

Country of location

Line of activity of the JV/WOS

Amount of equity

Amount of loan

Amount of guarantee

approved during the month

remitted during the month

approved during the month

remitted during the month

approved during the month

remitted if any, during the month under invoked guarantee

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

Total :

Equity

Loan

Guarantee

(a)

(b)

(c)

(i)

Total amount approved till the end of the previous month.......

(ii)

Approvals accorded during the month ...........................

(iii)

Cumulative approvals till end of the month [(i)+(ii)]..........

Stamp/Seal

(Signature of Authorised Official)

Name :_________________________

Place

:

___________________

Designation :____________________

Date

:

___________________