How to complete your payment

We will only accept one payment per payment reference. To make multiple payments, please repeat the process
to create a new payment reference number.

Payment reference Currency Amount to be paid

EGBAA40015783936 INR 7,598.00

This quote can only be used for one (1) payment is valid until 13/03/2023 00:37:30 GMT

1 Complete the attached ICICI form

You must print and complete the attached form. It is important the form is completed to ensure efficient
processing of your payment. Here are some tips to help you:
• Section I: the payer must provide their name, address and phone number.
• Section II (b): ensure the INR amount listed is correct and fill in the same amount in words.
• Section III: only complete this section if you will make your payment from an ICICI bank account.
• Section IV (a-g): this section does not need to be completed.
• Section V: fill in the Education section only providing the Student Name, Student ID and Country of Study.
• Signature of Remitter: sign and date the form at the end of the declaration on page 6.

2 a. Setup your payment

Non-ICICI account holders must transfer
If you are paying from your ICICI bank account, you must funds to the ICICI Bank pooled account via
complete Section III of the below A2 form. ICICI will debit NEFT or RTGS before visiting a branch:
your nominated account following your visit to your local
ICICI bank branch. Beneficiary: Outward Remittance Pool Account

Please note: TCS may be levied by ICICI over and above Account Number: 0035SLORCBPC
the payment instruction amount as per regulation and IFSC Code: ICIC0000035
you will be required to pay this. The TCS will be applied
during your visit at the bank branch.

b. Visit the nearest ICICI Bank location to complete the transaction

Select the Forex enabled branch from services section dropdown. You must bring the following with you to
your local ICICI branch:
• A completed Retail Outward Remittance Application – A2 cum LRS Declaration
• Proof of identity and address, either a Passport, Drivers License, Voter ID, Aadhaar Number, Letter from the
National Population Register OR Job Card issued by NREGA and signed by the State Government Office
• Your PAN card
• A copy of your Sanction letter (if your fees are being funded by a bank loan).

3 Track your payment as it is delivered to:

With the help of Convera, ICICI will deliver your payment to AA School Globalpay for Students
Funds will arrive at your institution in 2-3 business days.
Track your payment using the link below.

students.convera.com/#!/tracking

Email us at: [email protected]

Please include payment reference number and proof of payment number for prompt response and resolution.

Convera UK Financial Limited (registered in England, Company Number 13682869, Registered Office Address: Alphabeta Bui

V-22-0174-2022-09
 Retail Outward Remittance Application - A2 Cum LRS Declaration

Track Number Originating Br. ID Scan Br. ID AD Code

Additional Information
( if any )

(To be completed by the applicant in block letters using black ink pen)

Application for drawal of Foreign Exchange

I. Details of the Applicant (Remitter)

a. Name of the Applicant

b. Address (Not mandatory

for ICICI A/c holders)

c. Applicant Phone No. d. PAN*

(*PAN no. is mandatory for all resident customers)

II. Details of Foreign Exchange required (Fill-up either II a or II b) (Ref Annex-III for applicable Currency Details) II a. For remittance
of fixed amount of Foreign Currency

Foreign Currency GBP FC

Amount
FC Amt in figures In Words
(OR) II b. For remittance in Foreign Currency equivalent to Fixed Rupee Amount

Foreign Currency INR INR

Amount
INR Amt in figures 7,598.00 In Words

II c. Please enter the CCIL Deal Reference Number, in case deal already booked with CCIL platform (In case no deal booked with CCIL, please write NA)

_________________________________________________________________________________________
II d. Purpose of Remittance with Remittance Scheme and Purpose Code
(Please tick (√) against the purpose code in Annexure – I)

Whether under LRS (Yes/No) Purpose Code Purpose Description

I / We, being a person(s) resident in India, hereby declare and confirm that the beneficiary of the above transaction is not a person
resident in India.

II e. Name of the country providing ultimate services:

(in case payment is for import of services for below Purpose Groups)____________________________________________________
02 (Transport) 09 (Charges for the use of intellectual property)
03 (Travel) 10 (Other Business Services)
05 (Construction Services) 11 (Personal, Cultural & Recreational services)
06 (Insurance and Pension Services) 15 (Others)
07 (financial Services) 16 (Maintenance and repair services)
08 (Telecommunication, Computer & Information Services) 17 (Manufacturing services (goods for processing)

III. I / We authorize you to debit my / our below Account together with your charges* III a. Please issue

Telegraphic Transfer Demand Draft

OR
TT DD

*For ICICI Bank charges please refer our website www.icicibank.com

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 Retail Outward Remittance Application - A2 Cum LRS Declaration
IV. Beneficiary Name

W E S T E R N U N I O N

B U S I N E S S S O L U T I O N S

IV a. Beneficiary Address

2 0 0 H A M M E R S I T H R O A D

L O N D O N W 6 7 D L U K

IV b. Beneficiary A/c Number (Incase of TT)

IV c. Name of the Bank where the beneficiary A/c is maintained (In case of TT)

IV d. SWIFT & SORT Code details of beneficiary Bank (In case of TT)
IBAN for remittance made to UK, Transit Code for remittance
Europe, Bahrain Saudi made to Canada
Arabia & UAE

Sort Code for remittance to UK SWIFT code (or) routing

(or) BSB Code for remittance Number of beneficiary bank
to Australia

IV e. Beneficiary National ID/Commercial registration/Certificate Number (mandatory if beneficiary country is Saudi Arabia)

IV f. Beneficiary Bank address including Country at which the beneficiary maintains A/c (mandatory in case of TT in CAD, QAR & JPY Currencies)

IV g. Furnish the following details of CORRESPONDENT BANK if the Foreign Currency is sent to a Country other than the home Country of the Currency (Eg.
Remitting GBP currency to a beneficiary residing in Australia)

SWIFT CODE CORRESPONDENT BANK NAME

V a. If the purpose selected is one of the below then it is mandatory to furnish the details sought for
Maintenance Relationship of beneficiary
(Ref Table below)

Purchase of Immovable The location of property being purchased Country____________________________________

Property (Country / State) State_______________________________________

Education Student Name and Student ID (if any).

Country of study abroad

I/We hereby confirm that remittance request is to meet the incidental expenses in the country of emigration and
Emigration
not for undertaking any capital account transactions such as overseas investment in government bonds; land;
(Please check to agree)
commercial enterprise; etc.

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 Retail Outward Remittance Application - A2 Cum LRS Declaration

Investment abroad Below is the nature of investment

(Select the nature of investment) (Select 1 or 2 or 3 as applicable)
1. Equity Shares* 1. Remittance to own account abroad for the purpose of equity portfolio investment
2. Debt Security*
2. Remittance to own brokerage / demat / security trading a/c abroad for the purpose of equity portfolio investment

1. Name of Company (If available) : _____________________________________________________________________________

2. Listed / Unlisted (Please indicate): (mandatory)
3. Name of Stock Exchange if investment in listed company Where Listed _______________________________: (mandatory)
I hereby confirm and understand that the amount of foreign exchange remitted is under Overseas Portfolio Investment
(OPI), investment is below 10% without any controlling power.
Note : Investment in Unlisted foreign Entity will be treated as ODI.

1. Remittance to Company or Other Individual/Entity for Direct Purchase of Equity Shares. Further details of the
referred investment are as under:
Nature of Investment :
1. Name of Company___________________________________________________________________________________________
2. Listed / Unlisted (Please indicate)
3. Name of Stock Exchange Where Listed ________________________________________________________________________
4. Country of Incorporation ______________________________________________________________________________________
5. Number of shares to be acquired
6. Whether (the investor) holds any Controlling power in Foreign entity Yes No
7. Percentage of equity shares :
a. To be acquired – _____________ %
b. Overall holdings – _____________ %
8. Will investment be subscribed to the Memorandum of Association of the overseas entity Yes No
9. Whether any other financial commitments such as investment in Optionally Convertible Preference Shares, Loan,
Guarantee, etc in the overseas entity will be undertaken Yes No
10. Investment is made in existing entity and already incorporated by others Yes No
11. Remitter Beneficiary relationship (Investor /Other , Please specify) of other__________________________________

*Note : Investment in Unlisted foreign Entity will be treated as ODI.

Investment abroad • Name of the company :________________________________________________________________________________________

(Select the nature of investment) • Name of the instrument :______________________________________________________________________________________
• Regulated by (like SEC, FCA etc.):______________________________________________________________________________
• Venture Capital
• Mutual Fund The remittance is towards the investment in Venture Capital /Mutual Fund in Overseas duly regulated by the regulator for
• Promissory Notes the financial sector in the host jurisdiction.
The remittance is towards investment (including sponsor contribution) in units of investment fund overseas, duly regulated
by the regulator for the financial sector in the host jurisdiction shall be considered as OPI.

Purchase of ESOP Refer annexure 18

List of relatives (‘relative’ as defined in Section 2(77) of the Companies Act, 2013)

Father (including Step Father) Son’s wife Member of HUF Husband (or) Wife

Mother (including Step Mother) Daughter Daughter’s Husband Sister (Including Step Sister)

Brother (including step Brother) Son (Including step Son)

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 Retail Outward Remittance Application - A2 Cum LRS Declaration

VI. Please tick (√) against the appropriate box

<- - - - - - - - - - - - - - - - - - Limit Category - - - - - - - - - - - - - - - - - - >
Customer Category LRS LRS NRO Net No Others
$ 250 K $ 1 Mio Salary Limit ( Mention the Limit in USD )

Resident Indian

NRI / PIO

a) NRE / FCNR A/c

b) NRO A/c of an NRI / PIO

Foreign National
a) Foreign Tourist

b) Employed in India

Trust / Association / Society / Club

Others

If Limit Category “Others” is chosen, then enclose necessary supporting documents.

VI. Furnish below if a message to be sent along with wire transfer on your behalf
EGBAA40015783936

VII. Source of Funds (only for transfer from NRO accounts)

Sl No Source of Funds Amount (INR)

Please add a separate sheet for more Sources of Funds to declare

VIII Details for Standing Instruction (for resident individuals only) for the transaction details as mentioned above (Applicable for remittance for
the purpose of maintenance of close relative abroad / education abroad only):

VIII a. Number of
installments_____________________________________________________________________________________________________________

VIII b. Frequency of Standing lnstruction: Monthly/quarterly/half yearly (valid till March 31, 20XX)

VIII c. Valid From D D M M Y Y Y Y Va lid To D D M M Y Y Y Y

VIII d. Amount per installment in Foreign Currency

Foreign Currency FC
Amount
FC Amt in figures In Words

(OR) VIII e. Amount per installment in INR

Foreign Currency INR
Amount
INR Amt in figures In Words

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 Retail Outward Remittance Application - A2 Cum LRS Declaration

Declaration (Under FEMA 1999)

* I/we hereby declare that the total amount of foreign exchange purchased from or remitted through all sources in India during this financial
year including this application is within overall limit of the Liberalised Remittance Scheme prescribed by the Reserve Bank of India and certify
that the source of funds for making the said remittance belongs to me and the foreign exchange will not be used for prohibited purposes.
* The total amount of foreign exchange purchased from or remitted through, all sources in India during this financial year including this
application is within USD ________________________________________(USD __________________) the annual limit prescribed by Reserve Bank
of India for the said purpose.
* Foreign exchange purchased from you is for the purpose indicated above.
* The above remittance is NOT for investment / purchase of Bitcoin/Cryptocurrencies/Virtual Currencies (such as Ethereum, Ripple, Litecoin,
Dash, Peercoin, Dogecoin, Primecoin, Chinacoin, Ven, Bitcoin or any other virtual currency/cryptocurrency/bitcoin).
* The above remittance is NOT for investment in units of mutual funds/shares or any other capital instrument of a company dealing in
Bitcoins/Cryptocurrency/Virtual Currencies.
* The source of funds for the proposed Remittance is NOT proceeds from redemption of investment in Cryptocurrency /Bitcoins/Virtual
Currencies and also end use of.
* I confirm that the aforesaid declarations and statements are true and correct to the best of my knowledge and belief.
* I/ We hereby declare that the transaction mentioned above doesn’t involve, and is not designed for any purpose for which the drawing of
foreign exchange is prohibited under rule 3 of the FEMA Current A/c transactions Rules, 2000 read with schedule I therefore of Viz,
1. Travel to Nepal & or Bhutan
2. Transaction with a person resident in Nepal or Bhutan
3. Remittance out of lottery winnings
4. Remittance of Income from Racing / riding etc. or any other hobby.
5. Remittance for purchases of Lottery tickets, banned or prescribed magazines, football pools, sweep stakes, schemes involving money
circulations, securing prize money awards etc.
6. Payment of commission on exports made towards equity investments foreign entity abroad of Indian Companies
7. Remittance of dividend by any company to which the requirement of dividend balancing is applicable.
8. Payment of commission on export under rupee state credit route except commission up to 10% in invoice value of exports of Tea &
Tobacco.
9. Payment related to “Call back services” or telephones.
10. Remittance of interest income on funds held in non-resident special rupee a/c schemes.
* I / We, being a person(s) resident outside India, hereby declare that under Sec 4(b) of FEMA Permissible Capital A/c Transaction regulation,
2000, the transaction mentioned above doesn’t involve and is not designed for any repatriation outside India out of the proceeds of any
investment in India, in any form, in any Company, Partnership firm (or) Proprietary concern or any entity, whether incorporated or not, which
is engaged or proposes to engage a. In the business of chit funds or
a. In the business of chit funds or
b. As Nidhi company or
c. In agricultural or plantation activity, or
d. In real estate business, or construction of farm houses (real estate business shall not include development of townships construction of
residential / commercial premises roads or bridges), or e. In trading and transferable development rights (TDRs)
* I / We being a person(s) resident outside India, hereby declare that no portion / part of outward remittance represents interest on refunds of
funds received from outside India for purchase of shares in India. Updated list of prohibited transactions under FEMA can be accessed on ICICI
Bank website (www.icicibank.com).
e. (This remittance is towards Investment in Equity under Overseas Portfolio Investment (OPI) and not for trading in forex or any other
margin-based trading or not under ODI or any other purpose prohibited as per the terms and conditions of the Liberalised Remittance
Scheme for resident Individuals.
1. That the investment is in the shares of an existing company and is not intended to create a Joint Venture or Wholly-Owned Subsidiary outside
India*.
I/We hereby declare that the remitted funds under Liberalized Remittance Scheme (LRS) on the investments if received/realized / unspent
/ unused foreign exchange, unless reinvested, shall be repatriated to an authorized dealer within a period of 180 days from the date of such
receipt/ realization/ purchase/ acquisition
I/We agree and understand that my/our Aadhaar number is not required by ICICI Bank for processing of my/our transaction request. I/We
further agree and confirm that in the event my/our Aadhaar number is voluntarily provided by me/us at any time during the processing of
my/our transaction request, the same shall be strictly at my/our risk and responsibility and ICICI Bank shall not be liable for any losses or
consequences arising therefrom in any manner whatsoever. “We reiterate, please do not provide the Aadhar number, since not required by
the Bank to process this transaction”.

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 Retail Outward Remittance Application - A2 Cum LRS Declaration
Other relevant declarations:
• I/we hereby declare that the purpose and transaction details as mentioned above are true to the best of my knowledge does not involve, and
is not designed for the purpose of any contravention or evasion of the provisions of the FEMA, 1999 or any rule, regulation, notification,
direction or order made there under. I/We agree that I/We shall be responsible and liable for any incorrect detail provided by me/us.
• I/We also hereby agree and undertake to give such information / documents as will reasonably satisfy you about this transaction in terms of
the above declaration.
• I/we agree that in the event of transaction could not be executed/debited to my/ our account after submitting the request for processing to the
bank on account of insufficient/ unclear balance at the same time of execution of the transaction in my/ our account any exchange losses
incurred in this connection due to reversal of the Forex deal can be charged to my/our ICICI account.
• I/we agree that in the event the transaction is cancelled or revoked by me/us after submitting the request for processing to the bank any
exchange losses incurred in this connection can be charged to my/our ICICI account. I/we further agree that once the funds remitted by me/us
have been transmitted by ICICI bank to the correspondent and/or beneficiary banks, ICICI bank shall not be responsible for any delays in the
disbursement of such funds including the withholding of such funds by the correspondent and/or beneficiary banks. I/We further agree that
once the funds remitted by me / us have been transmitted by ICICI Bank, intermediary Bank charges may be levied by Correspondent and / or
Beneficiary Banks, which may vary from bank to bank.
• I/we agree that if the information provided by me/us is found to be incorrect / incomplete by the beneficiary bank / intermediary bank, it may
result in transaction to be rejected.
In this situation, ICICI Bank will try to contact me for any revised instruction as may be required for completion of transaction, & amendment
charges will be debited / recovered from my/our account ( If applicable) . If I / we do not respond within the specified time then the funds
would be re-credited to my ICICI Bank account at the prevailing exchange rate and any charges levied by the beneficiary bank / intermediary
bank and exchange losses incurred in this connection will be borne by me and same will be adjusted from the amount payable to or
recovered from my/our ICICI bank account. Also, the LRS limit (if applicable) for the transaction processed will stand utilized. I am aware that
the Tax Collected at Source (TCS), if applicable and Goods and Service Tax (GST) amount deducted at the transaction initiation will not be
refunded. I/we indemnify ICICI Bank against any loss incurred to me/us.
• I/we also understand that if I/we refuse to comply with any such requirement or make only unsatisfactory compliance therewith, the bank
shall refuse in writing to undertake the transaction and shall, if it has reason to believe that any contravention/evasion in contemplated by
me/us, report that matter to the RBI.
• I/we also agree that the exchange rate will be applicable at the time of deal booking and may vary from the rate prevailing when the request
is submitted. I/we also understand that the rate communicated to us (if any) is an indicative rate and the actual rate may be different from
the same.
• I / We authorize you to remit outwardly as per details provided in the application.
• I hereby declare that where the cumulative amount of remittance under the Liberalized Remittance Scheme (LRS) exceeds INR 7,00,000.00 in
the current financial year, then a Tax Collected at Source (TCS) shall be charged at 5% on the amount of remittance exceeding INR
7,00,000.00.
• In the event where the amount has remitted for the purpose of pursuing education through a loan obtained from a specified financial
institution in India, then the rate of applicable TCS shall be 0.5% on the amount excess of INR 7,00,000.00.
• I hereby declare to maintain sufficient balance in my account with ICICI Bank for deduction of the TCS at the applicable rate.
• I understand that my failure to maintain sufficient balance for processing the transaction and deduction of TCS in my account may result in
the transaction not being processed and I shall not hold ICICI Bank liable for the same and I authorize ICICI Bank to debit my account at a
subsequent date for deduction of the amount of TCS, as applicable.
• I hereby confirm to furnish a copy of my Permanent Account Number (PAN) to ICICI Bank, failing which TCS would be collected at source at
higher rate, as may be applicable.
• I/We agree to maintain sufficient balance in my account with ICICI Bank for deduction of the future scheduled SI and authorize ICICI Bank to
auto debit my account for the SI and charges/taxes etc, in the event of insufficient funds in the account in which the standing instructions to
debit my/our account (“Standing Instruction(s)” / “SI”) are set up or in the event the savings account is funded after the due date of the
Standing Instruction, ICICI bank shall not be liable for any delay and/or cancellation of the transaction to be executed basis the Standing
Instruction.
• I/We agree that the exchange rate for the Standing Instructions shall be as applicable at the time of deal booking and may vary from the rate
prevailing when the request for Standing Instructions is submitted by me/us. I/we also understand that the rate communicated to us (if any)
is an indicative rate and the actual rate may differ from the same.
• I/We agree that all transactions for Standing Instructions shall be processed only on working days, (public holidays as per Negotiable
Instruments Act, 1882, Saturday and Sunday shall be excluded from working days). In the event where the Standing Instructions are due to
be processed on a non-working day including any public holiday then the Standing Instructions will be processed on the next working day.
• I/We agree that ICICI bank reserves the right to demand any clarifications or additional documentation for scrutinizing the transactions which
are executed on the basis of the Standing Instructions. I/We also agree that ICICI bank shall not be responsible for any loss caused due to
delay in processing the transactions executed on the basis of Standing Instructions including due to any additional scrutiny conducted by
ICICI bank in respect of such transactions.
• I/We agree and understand that in the event of any request for cancellation of the Standing Instructions by me/us, the transaction basis the
immediately succeeding Standing Instruction will not be processed by ICICI bank and ICICI bank shall not be responsible for the same.
• I/We agree that ICICI bank shall not be responsible in the event where the transaction basis any Standing Instruction is auto-cancelled due
to my/our failure to address the queries raised by ICICI bank while processing such transaction. I/We understand that on the occurrence of
such auto-cancellation of any transaction due to my/our failure to address the queries, all subsequent Standing Instructions shall continue.
• I/We agree that all transactions which are executed by setting up Standing Instructions shall have to be compliant with applicable laws and
rules and regulations of the RBI and / or any other statutory or regulatory authority and ICICI bank reserves the right to reject executing a
transaction on the basis of the Standing Instructions and/or suspend the Standing Instructions which may be in breach of applicable laws
and rules and regulations of the RBI and / or any other statutory or regulatory authority

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 Retail Outward Remittance Application - A2 Cum LRS Declaration
Terms and Conditions related to CCIL:
1. Deal booked on CCIL Platform has to be utilized for underlying forex transactions only.
2. All unutilized deal will be cancelled on maturity and loss arising out of cancellation will be recovered from customer’s account. Gains, if any,
arising out of such cancellation will not be passed on to the customer. Retail Outward Remittance Application - A2 Cum LRS Declaration
3. ICICI Bank has the right to reject the transaction request, on following grounds:
• In case of incorrect Deal number shared by the customer; or
• Deal unavailability in our system, due to expired deal / already utilized deal4. Deals beyond maturity won’t be acceptable.
4. Deals beyond maturity won’t be acceptable.
5. Each deal will be considered separate and in case of reversal there won’t be any netting off the deals.
6. Separate deal has to be booked for each product (e.g. for Remittance & Travel Card) and combined deal could not be adjusted for multiple
transactions.
7. Once the deal is booked on CCIL platform, client will be fully responsible for the utilization of the deal with the settlement bank.
8. Deal booked and underlying request should be of same currency.
9. Client needs to submit documents along with the transaction. Outward deal to be utilized same day and inward deal to be utilized on or
before maturity.
10. Deal done through CCIL cannot be utilized for online reload or refund of travel card and physical currency.
11. The customer has to abide by all the Terms & Conditions of CCIL for trading in FX Retail platform.

To be filled in by residents only if the remittance is made under LRS

Declaration for purchase of Foreign Exchange under the Liberalised Remittance Scheme (LRS) of USD 250,000 for Resident Individuals
Mandatory details to be provided for remittance under LRS

Source of funds for remittance under LRS

Details of the remittances made/transactions effected under the Liberalised Remittance Scheme in the current financial year (April - March) ...............

SN Date Amount Name and Address of AD Branch / FFMC through which the transaction has been effected

Please add a separate sheet for more details of remittances to declare

I / We hereby declare that the total amount of Foreign Exchange purchased from (or) remitted abroad through all sources in India during the
financial year as given above, including utilization of the said limit on account of Loan extended or gift made in Indian Rupees credited to NRO
A/c of Non Resident Close relative(s), is within the limit of USD 250,000/- (US Dollar Two Lakh Fifty Thousand Only), which is the limit
prescribed by RBI for the purpose and certify that the source of funds for making the said remittance belong to me and will not be used for
prohibited purposes. Foreign exchange purchased from you is for the purpose indicated above.
I / We, being a person(s) resident in India, hereby declare that for transactions done under the Liberalised Remittance Scheme (LRS) for resident
individuals, issued and amended by RBI from time to time, is not in the nature of remittance for margin calls to overseas exchanges / overseas
counter parties under this scheme.

.............................................................................................
Signature of Remitter / Guardian in case of Minor

Date ………………….… Signature of Remitter / POA (or) Mandate Holder / Guardian in case of Minor

(The signature by mandate holder will be accepted only for Non-resident A/c holders where mandate is duly registered with the Bank )
I certify that I have verified the Customer’s signature as per Bank records and retained the originals of all the scanned documents and forms
submitted by the remitter for the above transaction.

I also certify that in case of LRS the remittance is not being made by / to ineligible entities and that the remittance is in conformity with the
instructions issued by the Reserve Bank from time to time under the Scheme.

Name & Employee ID Date & Place Bank Stamp & Employee Signature

AD / Branch Official should put a tick against appropriate purpose code Annexure - I

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 Retail Outward Remittance Application - A2 Cum LRS Declaration

PURPOSE PURPOSE CODE DESCRIPTION FOR REPORTING UNDER FETERS

CODE

Capital Account

S0017 Acquisition of non-produced non-financial assets (Purchase of intangible assets like patents, copyrights, trademarks etc., land
acquired by government, use of natural resources) – Government
S0019 Acquisition of non-produced non-financial assets (Purchase of intangible assets like patents, copyrights, trademarks etc., use
of natural resources) – Non-Government
S0026 Capital transfers ( Guarantees payments, Investment Grand given by the government/international organization, exceptionally
large Non-life insurance claims) – Government
S0027 Capital transfers ( Guarantees payments, Investment Grand given by the Non-government, exceptionally large Non-life
insurance claims) – Non-Government

Foreign Direct Investment

S0003 Indian Direct Investment abroad (In Branches and wholly owned Subsidiaries)

S0004 Indian Direct investment abroad (in subsidiaries and associates) in debt instruments

S0005 Indian investment abroad – in real estate

S0006 Repatriation of Foreign Direct Investment made by overseas Investors in India – in equity shares

S0007 Repatriation of Foreign Direct Investment in made by overseas Investors India – in debt instruments

S0008 Repatriation of Foreign Direct Investment made by overseas Investors in India – in real estate

Foreign Portfolio Investments

S0001 Indian Portfolio investment abroad – in equity shares

S0002 Indian Portfolio investment abroad – in debt instruments

S0009 Repatriation of Foreign Portfolio Investment made by overseas Investors in India – in equity shares

S0010 Repatriation of Foreign Portfolio Investment made by overseas Investors in India – in debt instruments

External Commercial Borrowings

S0011 Loans extended to Non-Residents

S0012 Repayment of long & medium term loans with original maturity above one year received from Non-Residents

Short Term Loans

S0013 Repayment of short term loans with original maturity up to one year received from Non-Residents

Banking Capital

S0014 Repatriation of Non-Resident Deposits (FCNR(B)/NR(E)RA)

S0015 Repayment of loans & overdrafts taken by ADs on their own account.

S0016 Sale of a foreign currency against another foreign currency

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 Retail Outward Remittance Application - A2 Cum LRS Declaration
Financial derivatives and others

S0020 Payments made on A/c of margin payments, premium payment and settlement amt etc. under Financial derivative transactions.

S0021 Payments made on account of sale of share under Employee stock option

S0022 Investment in Indian Depositories Receipts (IDRs)

S0023 Opening of foreign currency account abroad with a bank

External Assistance

S0024 External Assistance extended by India. e.g. Loans and advances extended by India to Foreign Govt. under various agreements

S0025 Repayments made on account of External Assistance received by India.

Imports

S0101 Advance payment against imports made to countries other than Nepal and Bhutan

S0102 Payment towards imports- settlement of invoice other than Nepal and Bhutan

S0103 Imports by diplomatic missions other than Nepal and Bhutan

S0104 Intermediary trade/transit trade, i.e., third country export passing through India

S0108 Goods acquired under merchanting / Payment against import leg of merchanting trade*

S0109 Payments made for Imports from Nepal and Bhutan, if any

Transport

S0201 Payments for surplus freight/passenger fare by foreign shipping companies operating in India

S0202 Payment for operating expenses of Indian shipping companies operating abroad

S0203 Freight on imports – Shipping companies

S0204 Freight on exports – Shipping companies

S0205 Operational leasing/Rental of Vessels (with crew) –Shipping companies

S0206 Booking of passages abroad – Shipping companies

S0207 Payments for surplus freight/passenger fare by foreign Airlines companies operating in India

S0208 Operating expenses of Indian Airlines companies operating abroad

S0209 Freight on imports – Airlines companies

S0210 Freight on exports – Airlines companies

S0211 Operational leasing / Rental of Vessels (with crew) – Airline companies

S0212 Booking of passages abroad – Airlines companies

S0214 Payments on account of stevedoring, demurrage, port handling charges etc.(Shipping companies)

S0215 Payments on account of stevedoring, demurrage, port handling charges, etc.(Airlines companies)

S0216 Payments for Passenger - Shipping companies

S0217 Other payments by Shipping companies

S0218 Payments for Passenger - Airlines companies

S0219 Other Payments by Airlines companies

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 Retail Outward Remittance Application - A2 Cum LRS Declaration

S0220 Payments on A/c of freight under other modes of transport (Internal Waterways, Roadways, Railways, Pipeline transports and others)

S0221 Payments on account of passenger fare under other modes of transport (Internal Waterways, Roadways, Railways, Pipeline transports and others)

S0222 Postal & Courier services by Air

S0223 Postal & Courier services by Sea

S0224 Postal & Courier services by others

Travel

S0301 Business travel.

S0303 Travel for pilgrimage

S0304 Travel for medical treatment

S0305 Travel for education (including fees, hostel expenses etc.)

S0306 Other travel (including holiday trips and payments for settling international credit cards transactions)

Construction Services

S0501 Construction of projects abroad by Indian companies including import of goods at project site abroad

S0502 Cost of construction etc. of projects executed by foreign companies in India.

Insurance and Pension Services

S0601 Life Insurance premium except term insurance

S0602 Freight insurance – relating to import & export of goods

S0603 Other general insurance premium including reinsurance premium; and term life insurance premium

S0605 Auxiliary services including commission on insurance

S0607 Insurance claim Settlement of non-life insurance; and life insurance (only term insurance)

S0608 Life Insurance Claim Settlements

S0609 Standardized guarantee services

S0610 Premium for pension funds

S0611 Periodic pension entitlements e.g. monthly quarterly or yearly payments of pension amounts by Indian Pension Fund Companies.

S0612 Invoking of standardized guarantees

Financial Services

S0701 Financial intermediation, except investment banking - Bank charges, collection charges, LC charges etc.

S0702 Investment banking – brokerage, under writing commission etc.

S0703 Auxiliary services – charges on operation & regulatory fees, custodial services, depository services etc.

Telecommunication, Computer & Information Services

S0801 Hardware consultancy/implementation

S0802 Software consultancy / implementation

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 Retail Outward Remittance Application - A2 Cum LRS Declaration

S0803 Data base, data processing charges

S0804 Repair and maintenance of computer and software

S0805 News agency services

S0806 Other information services- Subscription to newspapers, periodicals

S0807 Off-site software imports

S0808 Telecommunication services including electronic mail services and voice mail services

S0809 Satellite services including space shuttle and rockets etc.

Charges for the use of intellectual property n.i.e

S0901 Franchises services

S0902 Payment for use, through licensing arrangements, of produced originals or prototypes (such as manuscripts and films), patents,
copyrights, trademarks and industrial processes etc.

Other Business Services

S1002 Trade related services – commission on exports / imports

S1003 Operational leasing services (other than financial leasing) without operating crew, including charter hire- Airlines companies

S1004 Legal services

S1005 Accounting, auditing, book-keeping services

S1006 Business and management consultancy and public relations services

S1007 Advertising, trade fair service

S1008 Research & Development services

S1009 Architectural services

S1010 Agricultural services like protection against insects & disease, increasing of harvest yields, forestry services.

S1011 Payments for maintenance of offices abroad

S1013 Environmental Services

S1014 Engineering Services

S1015 Tax consulting services

S1016 Market research and public opinion polling service

S1017 Publishing and printing services

S1018 Mining services like on–site processing services analysis of ores etc.

S1020 Commission agent services

S1021 Wholesale and retailing trade services.

S1022 Operational leasing services (other than financial leasing) without operating crew, including charter hire- Shipping companies

S1023 Other Technical Services including scientific/space services.

S1099 Other services not included elsewhere

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 Retail Outward Remittance Application - A2 Cum LRS Declaration
Personal, Cultural & Recreational Services

S1101 Audio-visual and related services like Motion picture and video tape production, distribution and projection services.

S1103 Radio and television production, distribution and transmission services

S1104 Entertainment services

S1105 Museums, library and archival services

S1106 Recreation and sporting activities services

S1107 Education (e.g. fees for correspondence courses abroad )

S1108 Health Service (payment towards services received from hospitals, doctors, nurses, paramedical and similar services etc. rendered remotely or on-site)

S1109 Other Personal, Cultural & Recreational services

Government not included elsewhere (G.n.i.e.)

S1201 Maintenance of Indian embassies abroad

S1202 Remittances by foreign embassies in India

Secondary Income

S1301 Remittance for family maintenance and savings

S1302 Remittance towards personal gifts and donations

S1303 Remittance towards donations to religious and charitable institutions abroad

S1304 Remittance towards grants and donations to other governments and charitable institutions established by the governments.

S1305 Contributions/donations by the Government to international institutions

S1306 Remittance towards payment / refund of taxes.

S1307 Outflows on account of migrant transfers including personal effects

Primary Income

S1401 Compensation of employees

S1402 Remittance towards interest on Non-Resident deposits (FCNR(B)/NR(E)RA, etc.)

S1403 Remittance towards interest on loans from Non-Residents (ST/MT/LT loans) eg. External Comm. Borrowings, Trade Credits, etc.

S1405 Remittance towards interest payment by ADs on their own account (to VOSTRO a/c holders or the OD on NOSTRO a/c.)

S1408 Remittance of profit by FDI enterprises in India (by branches of foreign companies including bank branches)

S1409 Remittance of dividends by FDI enterprises in India (other than branches) on equity and investment fund shares

S1410 Payment of interest by FDI enterprises in India to their Parent company abroad.

S1411 Remittance of interest income on account of Portfolio Investment in India

S1412 Remittance of dividends on account of Portfolio Investment in India on equity and investment fund shares

Others

S1501 Refunds / rebates / reduction in invoice value on account of exports

S1502 Reversal of wrong entries, refunds of amount remitted for non-exports

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 Retail Outward Remittance Application - A2 Cum LRS Declaration

S1503 Payments by residents for international bidding

S1504 Notional sales when export bills negotiated/ purchased/ discounted are dishonored/ crystallized/ cancelled and reversed from suspense account

S1505 Deemed Imports (exports between SEZ, EPZs and Domestic tariff areas)

Maintenance and repair services n.i.e

S1601 Payments on account of maintenance and repair services rendered for Vessels, ships, boats, warships, etc.

S1602 Payments on account of maintenance and repair services rendered for aircrafts, space shuttles, rockets, military aircrafts, helicopters, etc.

Manufacturing services (Goods and Processing)

S1701 Payments for processing of goods

(For Office Use Only)

Annexure-II KYC

KYC Certification

(To be filled and scanned only in case of remittance by non ICICI Customer)
I confirm having met Mr./Ms./Mrs. _______________________________ at the Branch / other location (specify)
Further, I confirm having verified the copies of below KYC documents (as applicable) with the originals produced by the applicant and that the
applicant has signed the documents in my presence.

ID Proof
Address Proof

Name of the Bank official ___________________________________________________________________ Employee No. ______________ Designation

___________

Date : _______________ Signature of the Branch Official and Branch stamp

Name of BM / BOM authorizing KYC certification above ________________________________________________ Employee No. __________________

Date : ______________ Signature of the Branch Official and Branch stamp

Details of INR amount credited to the pool a/c (Incl. of Charges + GST) _________________________________________________________________

Finacle Tran ID. __________________________________________________ IBR No. _________________________________________________________

Date of credit _____________________________________________ into Pool A/c No.0035SLORCBPC

(If the remittance is by way of accepting cash deposit then the amount should not exceed INR 50,000/-)

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

List of Approved Currencies for sending TT (or) DD_________________________________________________________________________ Annexure-III

CURRENCY TT DD CURRENCY TT DD CURRENCY TT DD

US Dollar (USD) √ √ Hong Kong Dollar (HKD) √ X Saudi Arabian Riyal (SAR) √ X
Great Britain Pounds (GBP) √ √ New Zealand Dollar (NZD) √ X Qatari Riyal (QAR) √ X
Euro (EUR) √ √ Japanese Yen (JPY) √ X Arab Emirates Dirham (AED) √ X
Canadian Dollar (CAD) √ √ Swiss Francs (CHF) √ X Danish Kroner (DKK) √ X
Australian Dollar (AUD) √ √ Swedish Kroner (SEK) √ X Norwegian Kroner (NOK) √ X
Singapore Dollar (SGD) √ √ South African Rand (ZAR) √ X Thai Bhat (THB) √ X
Poland Zloty √ X Omani Rial (OMR) √ X Bahraini Dinar (BHD) √ X

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