R-Return (NOSTRO) / (VOSTRO)………….…….

 

 

 

for the period ended……….

 

(Currency Name)

(Swift Currency Code)

Name and address of the AD

……………………..…………………………………………….……...

 

 

Date of

Name and

Country of

Country

Amount

Purpose

Purpose

purchase

address of

residence

Code

#

 

code

 

beneficiary

of remitter

*

 

 

*

 

 

 

 

 

 

 

1

2

3

4

5

6

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*

for use of RBI

#

Amounts in rounded units of currency

Place………….

STAMP

(Signature of Authorised Official)

 

 

Name……………………………

Date…………..

 

Designation……………………..