Form

Form A1

Document type: Form
Dated: 30 Apr 2012
Category: Documents & Forms

Application for Payment through Asian Clearing Union

Form A1 (for Import Payments only) Application for Payment through Asian Clearing Union	A. D. Code No. ___________________________ Form No._________________________________ (To be filled by authorised dealer)
	Serial No._________________________________ (for use of Reserve Bank of India)
	Amount remitted	_______	_______
		Currency	Amount
	Equivalent to Rupees: ________________________ (To be completed by authorised dealer)


   I/We wish to remit through ASIAN CLEARING UNION ____________________________________________								(Name of currency)_____________________________ through ______________________________________________________for   (Amount in words) 		  	(Name and address of the designated bank in India)payment to ______________________________________________________________ in payment of imports		(Name and address of the beneficiary of remittance) into India, detailed below:

Details of goods imported or to be imported into India
Section A: Import Licence/Open General Licence particulars

Import Licence								Date of Issue			Date of expiry
Prefix		Licence No.	Suffixes					Date	Month	Year	Date	Month	Year
1	2	Licence No.	1	2	3	4	5	Date	Month	Year	Date	Month	Year

@ Actual amount endorsed in rupees against each licence involved, should be stated under this column.

Note:: If more than one licence is involved, particulars of all licences should be furnished. If the space is inadequate, a separate statement may be attached. The amount utilised against each licence should invariably be indicated.

Section B: Import particulars

Invoice Details				Quantity of goods	Description of goods	Harmonised System of Classification	Country of origin of goods	Country from which goods are consigned	Mode of shipment(air, sea post, rail river,transport port, etc.)	Date of shipment (if not known approxi-mate date)
No and date	Terms(c.i.f., f.o.b., c.&.f. etc.)	Currency	Amount

Section C: Other particulars

Details of forward purchase contract, if any ,booked against the import	__________________ (No.& date of Contract)	__________________ (Currency and Amount of Contract)	__________________ (Balance under the contract)
If remittance to be made is less than invoice value, reasons therefor (i.e. part remittance, instalment etc.)	____________________________________________________________________ ____________________________________________________________________

I/We hereby declare that the statements made by me/us on this form are true and that I/we have not applied for an authorisation through any other bank.

I/We declare and also understand that the payments to be made by me/us, through ASIAN CLEARING UNION pursuant to this application shall be used by me/us only for the purpose stated above and that the conditions subject to which the permission is granted will be complied with.

		(Signature of Applicant/Authorised Official)
		@ Name and Address of Applicant…………
	Stamp	Importers Code Number……………………
		@ Nationality ……………………………..
Date:....................		@ To be filled in capital letters

NOTE: For remittances covering intermediary trade, form A2 should be used.

Declaration to be furnished by Applicant(s)

I/We declare that

the import licence/s against which the remittance is sought is/are valid and has/have not been cancelled by DGFT.
the goods to which this application relates have been* imported into India on my/our own account*
the import is on behalf of @_______________________________________* and
the invoice value of the goods which is declared on this form is the real value of the goodsimported*

to be imported*

into in India.

If the Import has been made	I/We attach the relative Customs-stamped Exchange Control copy of Bill of Entry * Post parcel wrapper (for imports by post)/Courier Wrapper (for imports through courier)
Or
If the import is to be made	I/We undertake to produce within three months to the authorised dealer the relative Customs-stamped Exchange Control copy of Bill of Entry* Post parcel wrapper (for imports by post)/Courier wrapper (for imports through Courier)
* Strike out item not applicable

@ Where the import is on behalf of Central/State Government Department or a company owned by Central/State Government/Statutory Corporation, Local Body, etc. the name of the Government Department, Corporation etc. should be stated.

Date:	..............................	............................................................................
		(Signature of Applicant/Authorised Official)

Space for comments of the authorised dealer
(While forwarding the application to Reserve Bank for approval, reference to Exchange Control Manual paragraph/ A.D.Circular in terms of which the reference is made should invariably be cited. If any remittance application on account of the same import was referred to Reserve Bank earlier, reference to the last correspondence/approval should also be cited).

		(Signature of Authorised Official)
		Name
	Stamp	Designation
		Name and Address of
Date:....................		Authorised dealer

Certificate to be Furnished by Authorised Dealer (Importers Banker)
We hereby certify that

(a) this payment is

Put a tick (a) in the relevant block	(i)	c	an advance remittance
	(ii)	c	in retirement of bills under Letter of Credit opened through us
	(iii)	c	against documents received through our medium for collection
	(iv)	c	on account of documents received direct by the applicant/s againstundertaking furnished by the latter to submit Customs-stamped Exchange Control copy of Bill of Entry of Post Parcel/courier wrapper within three months
	(v)	c	on account of documents received direct by the applicant/s against Customs-stamped Exchange Control copy of Bill of Entry/post parcel/courier wrapper(attached) submitted by the latter
	(vi)	c	_____________________________________________________________________ (any other case, to be explained)
	(b) all the Exchange Control regulations applicable to the remittance have been complied with
	(c) the payment to the supplier of the goods has been/ made will be through____________________________________________________________________ (Name & Address of the foreign bank)

We also certify/undertake that the relevant Customs-stamped Exchange Control copy of Bill of Entry or post parcel/courier wrapper

shall be verified by us within three months [vide certificate (a)(ii) and (iii) above].

has been verified [vide certificate (a) (v) above].

shall be obtained from the applicant/s within three months[vide certificate (a) (i) and (iv) above].

		(Signature of Authorised Official)
		Name
	Stamp	Designation
		Name and Address of
Date:....................		Authorised dealer

* Strike out item not applicable

Form A1

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