Application for remittance of income/interest earned by NRIs/OCBs from their investments/deposits etc. held with Indian companies on non-

repatriation basis during the financial year ended

1.

The application should be completed in a consolidated manner giving full particulars of all incomes earned during the last financial year and submitted to the branch of an authorised dealer designated for the purpose.

2.

The applicant should designate only one branch of an authorised dealer through whom the remittances are to be made annually.

3.

The designated branch of an authorised dealer should scrutinise the application and the documents attached thereto to ensure that it is complete in all respect.

4.

The designated branch should confirm that the applicant continues to be NRI/OCB.

5.

Incomes declared in Part A of the application should be certified by a Chartered Accountant in Part B of the form.

Documentation:

6.

Form A2 duly completed and signed by the applicant, if the remittance is desired to be made.

7.

Latest copy of OAC/OAC1 in case the applicant is an OCB.

Part A - General Information

1.

(a)

Name of the applicant

(b)

Present overseas Address

(c)

Local Address (for correspondence)

2.

If the applicant is an individual, please state -

(a)

Nationality, i.e. whether a

citizen of India or a foreign citizen

(b)

If foreign citizen, whether

a person of Indian origin

3.

If applicant is an OCB, please

state place of its incorporation

and the percentage of non-resident

interest held in it by NRIs

4.

Passport particulars

(in case of individuals)

(a)

Number

(b)

Country of issue

(c)

Date of issue

(d)

Date of expiry

5.

Purpose of applicants stay

abroad

(i)

If emigrated, please

state date of emigration

(ii)

If employment/business, etc.,

indicate the date of leaving India

6.

Name and address of the

designated branch of

an authorised dealer in India

through whom remittances of

income are proposed to be

made annually

7.

Whether the income is proposed

to be remitted to the beneficiary

or credited to his NRE/FCNR account

In the latter case the name of the

bank/s with which the account/s is/are

maintained may be indicated

8.

Financial year during which

income has been earned

April..........to March........

9.*

Details of investments/deposits

and incomes actually earned during

the above period and deposited in

NRO account

* NOTE:

Incomes accrued during the period prior to 31st March 1994 but received subsequently as well as incomes accrued by way of sale proceeds of assets (including capital gains) should not be included.

A.

Investment (on non-repatriation

Amount

Amount of income

basis) and incomes earnedinve- of

invested

earned during

thereon, insted income

The year

i)

Partnership firm/s

ii)

Proprietorship concern

iii)

Shares/Debentures of

Indian companies

iv)

Mutual funds floated by

public sector banks/

financial institutions/

others

v)

Government Securities/

UTI/NSCs etc.

B.

Deposits with Indian companies

and firms

C.

Deposits with banks in NRO Accounts

D.

Immovable property -

a)

residential

b)

commercial

c)

others

E.

Other investments

(please specify)

F.

Other earnings such as pensions

(please specify)

G.

Total income earned on non-repatriable

assets during the year

=========

H.

Less:

(a)

Taxes paid

(b)

Taxes payable

I.

Net income earned on non-repatriable

Rs.

assets during the above period

========

Place:

Date :

(Signature of applicant/authorised official)

Stamp

Name :

Designation:

We have verified the relevant records and hereby certify that -

(a)

The assets declared by the applicant were held by him in his name during the financial year ended...............under the general/special permission of Reserve Bank as required under FERA 1973 and the applicant has complied with the terms and conditions of such general/special permission.

(b)

The income/interest etc. earned and declared by the applicant under item 9 above has been actually earned by him during the year and credited to his NRO account/s.

(c)

The total amount of Income-tax paid/payable by the applicant as stated against item 9(H) above has been correctly arrived at as per the provisions of Income-tax Act, 1961.

(d)

The applicant has declared the income stated against item 9 of the form to the Income-tax authorities and has paid the Income-tax as applicable for the financial year.

Date :

(Signature of Chartered Accountant)

Stamp

Name :

Full address :

Registration No.:

Date :

(Signature of authorised Official)

Stamp

Name :

Designation:

Name & Address

of Authorised

Dealer: