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All Customer Declaration Formats

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Third-Party / Family Member Payment Declaration

Traveller / Applicant Details
Person Making the Payment
Payment Mode:NEFTRTGSIMPSChequeDemand DraftOther
Joint Declaration

We hereby declare that:

The person making the payment is the traveller’s:
FatherMotherSpouseSonDaughterBrotherSisterHead of FamilyEmployer / Sponsoring CompanyOther:
  1. The payment is being made voluntarily for the bona fide foreign exchange requirement of the above traveller / applicant.
  2. The funds are from legitimate and explainable sources and are not borrowed or received from any undisclosed third party for undertaking this transaction.
  3. The foreign exchange entitlement and LRS utilisation, wherever applicable, shall be accounted for against the traveller / applicant and not against the person making the payment.
  4. The payment is not being made for purchasing foreign exchange on behalf of an unknown or unrelated person.
  5. Both parties authorise the company to verify the relationship, bank account, source of funds and transaction particulars.
  6. Both parties accept responsibility for the correctness of the information and documents submitted.
Documents Submitted
Traveller’s PassportTraveller’s PANPayer’s PANPayer’s Bank StatementRelationship ProofSponsorship LetterCompany AuthorisationOther:
For Office Use
Payment received from permitted source:YesNo

Authorisation for Collection of Foreign Currency by Representative

Traveller Details
Representative Details
Authorisation

I hereby authorise the above-mentioned representative to collect the foreign currency / forex card / documents relating to my transaction on my behalf. I declare that:

I am unable to personally collect the foreign exchange due to:
Official commitmentsMedical reasonsTravel-related urgencyResidence outside the branch locationOther:
  1. The representative is personally known to me.
  2. The representative is authorised only to collect the foreign exchange and related documents and is not authorised to alter the transaction particulars.
  3. I have independently verified the currency, amount, rate, charges and transaction details.
  4. I accept responsibility for the foreign exchange once it has been delivered to the authorised representative.
  5. I authorise the company to obtain the representative’s photograph, identity proof, signature and delivery acknowledgement.
  6. I understand that the company may refuse delivery where the representative’s identity or authority cannot be satisfactorily established.
Delivery Acknowledgement

I acknowledge receipt of:

For Office Use
Original authorisation verifiedTraveller contacted and confirmation obtainedRepresentative’s original ID verifiedID copy retainedSignature matchedDelivery photograph obtained, where applicable

Comprehensive LRS Utilisation Declaration

Declaration

I hereby provide the details of foreign exchange purchased or remitted by me under the Liberalised Remittance Scheme during the current financial year through all banks, authorised dealers, FFMCs and other authorised persons.

DateName of Bank / Authorised PersonPurposeAmount in INRUSD Equivalent

I further declare that:

  1. The above information is complete and includes transactions undertaken through all authorised persons.
  2. I have not concealed any previous foreign exchange purchase, card loading or outward remittance.
  3. The proposed transaction, together with previous utilisation, is within the applicable annual LRS limit.
  4. The foreign exchange will be used only for the declared permitted purpose.
  5. I will be responsible for any regulatory, tax or financial consequence resulting from an incorrect declaration.
  6. I authorise the company to verify the information through available regulatory or banking systems.
For Office Use
TCS applicability checked:YesNo

Declaration for Visa on Arrival / e-Visa / Visa Not Required

Declaration
I declare that I am presently unable to submit a conventional visa sticker or stamped visa for the following reason:
The destination provides visa on arrival to eligible travellers.I hold a valid electronic visa / e-travel authorisation.A visa is not required for my nationality or category of travel.I hold a valid residence permit / work permit / student permit.I am transiting through the destination and do not require a visa.Visa approval has been issued electronically but is not endorsed in the passport.Other:

I further declare that:

  1. I have independently verified my eligibility to travel under the applicable immigration rules.
  2. I possess or will obtain all documents required for boarding and admission into the destination country.
  3. The company is not responsible for any denial of boarding, entry, immigration clearance or visa-related difficulty.
  4. I shall use the foreign exchange only for my genuine declared travel.
  5. I undertake to provide additional evidence of visa status if requested.
Supporting Documents
E-visa copyElectronic travel authorisationResidence permitWork / student permitOfficial immigration website printoutAirline confirmationInvitation letterOther:
For Office Use
Visa requirement independently checked:YesNo

Passport Address and Present Address Mismatch Declaration

Declaration
I declare that the address mentioned in my passport differs from my present residential address because:
I have shifted my residence.The passport contains my permanent / parental address.I am staying in rented accommodation.I have relocated due to employment / business / education.I have recently changed my address and the passport has not been updated.Other:

I confirm that:

  1. Both addresses relate to me.
  2. My current residential address stated above is complete and correct.
  3. I authorise the company to verify the present address through the documents submitted by me.
  4. I undertake to produce additional evidence if required.
  5. I shall inform the company if my address changes before completion of the transaction.
Present Address Proof Submitted
Aadhaar CardDriving LicenceVoter IDBank StatementUtility BillRegistered Rent AgreementEmployer LetterOther:
For Office Use
Original address proof verified:YesNo

Source of Funds Declaration

Occupation Details
Occupation:
SalariedBusinessProfessionalStudentRetiredHomemakerAgriculturistOther:
Source of Funds
The funds used for the present transaction are from:
Salary savingsBusiness incomeProfessional incomePersonal savingsFixed deposit maturitySale of property / investmentEducation loanPersonal loanFunds provided by parent / spouse / family memberEmployer sponsorshipScholarshipOther:

I declare that:

  1. The funds are derived from legitimate and explainable sources.
  2. The funds do not represent proceeds of crime, undisclosed third-party funds or funds connected with any prohibited activity.
  3. The payment is being made through my bank account or another specifically permitted source disclosed to the company.
  4. I authorise verification of the source of funds through bank statements, income records or other supporting documents.
  5. I accept responsibility for any incorrect or misleading information furnished by me.
Documents Submitted
Bank StatementSalary SlipIncome-tax ReturnLoan Sanction LetterSale DocumentSponsorship LetterScholarship LetterOther:
For Office Use
Source commensurate with customer profile:YesNo
Enhanced due diligence required:YesNo

Purpose Clarification Declaration

Declaration

I understand that a difference or apparent inconsistency has been observed among my documents regarding the purpose of my transaction.

DocumentPurpose / Description appearing in document
Visa
Air Ticket
Admission / Employment Letter
Invoice / Beneficiary Document
Customer Application
The apparent difference has arisen because:
My visa category permits multiple activities.The travel is connected with both business and personal activities.The document contains a general description, whereas the transaction has a specific purpose.My travel plan or purpose has subsequently changed.The visa / document was issued for an earlier or broader purpose.Other:

I confirm that:

  1. The purpose declared above is the actual and predominant purpose of the transaction.
  2. No false purpose has been declared to obtain a higher entitlement, lower TCS rate, regulatory exemption or other benefit.
  3. I have disclosed all relevant facts and supporting documents.
  4. I accept responsibility for the purpose classification based on the information furnished by me.
For Office Use

Unused Foreign Exchange Surrender Declaration

Foreign Currency Surrendered
CurrencyDenomination DetailsAmount
Source of Foreign Exchange:
Balance remaining from foreign travelForeign exchange purchased in IndiaSalary / savings earned abroadGift received abroadCurrency brought during visit to IndiaOther:

I declare that:

  1. The foreign currency tendered for surrender belongs to me and has been lawfully acquired.
  2. The currency is genuine to the best of my knowledge.
  3. The currency is not connected with any illegal, unauthorised or prohibited transaction.
  4. Where the original purchase document is available, I have submitted it for verification.
  5. Where the original purchase document is unavailable, I have separately declared the reason for its non-availability.
  6. I authorise the company to verify the travel, source and acquisition details.
For Office Use
Passport / travel details verified:YesNoNot Applicable
Original acquisition document verified:YesNo
Currency authenticated:YesNo
Payment Mode:CashBank Transfer

Loss / Non-Availability of Original Cash Memo or Encashment Certificate

Declaration
I declare that the original cash memo / encashment certificate issued in connection with the above transaction is unavailable because:
It has been lost.It has been misplaced.It was damaged or destroyed.It was retained by another authorised person / authority.It is currently inaccessible.Other:
I request the company to:
Process surrender of the unused foreign exchange.Provide a duplicate transaction document.Confirm details of the original transaction.Other:

I further declare that:

  1. I have not transferred, pledged or otherwise misused the original document.
  2. I have not used the same foreign exchange or document for any duplicate claim or transaction.
  3. I undertake to return the original document if it is subsequently found.
  4. I accept responsibility for any duplicate use or incorrect representation.
  5. The company may mark any duplicate document as “Duplicate Issued on Customer Declaration”.
For Office Use
Original transaction traced in records:YesNo
Transaction details matched:YesNo
Duplicate document issued:YesNo

Travel Cancellation and Forex Refund Declaration

Details of Forex Purchased
Declaration
I declare that my proposed travel has been:
CancelledPostponedRescheduledPartially completedChanged to another destination
I request:
Encashment of unused currency notesCancellation / unloading of forex cardCancellation of remittance requestRefund of available balanceOther:

I confirm that:

  1. The unused foreign exchange belongs to me.
  2. The foreign exchange has not been sold, transferred or used by another person.
  3. Any applicable cancellation charge, exchange difference, card charge, bank charge or administrative charge may be deducted.
  4. Refund will be made to the permissible source / account after necessary verification.
  5. Any related TCS adjustment or refund will be subject to the applicable tax procedure and records.
  6. I have submitted the available cancellation, revised itinerary or supporting documents.
For Office Use
Original payment source verified:YesNo

Minor Traveller / Parent or Guardian Declaration

Minor Traveller
Parent / Guardian
Declaration

I declare that:

  1. I am the natural / legal guardian of the above minor.
  2. I am applying for and funding the foreign exchange transaction on behalf of the minor.
The transaction is for the minor’s bona fide:
TravelEducationMedical treatmentFamily visitOther:
  1. The foreign exchange will be used solely for the declared purpose and for the benefit of the minor.
  2. The transaction shall be considered against the minor’s applicable LRS entitlement, wherever required.
  3. Details of any earlier foreign exchange purchased or remitted on behalf of the minor during the financial year have been fully disclosed.
  4. I accept responsibility for compliance with FEMA, LRS, tax and other applicable requirements.
  5. I authorise verification of the minor’s identity, relationship, source of funds and travel documents.
Documents Submitted
Minor’s PassportBirth CertificateParent’s / Guardian’s PANParent’s / Guardian’s IDGuardianship Order, where applicableTicket / VisaAdmission / Medical DocumentOther:
For Office Use
Relationship established:YesNo
Minor’s LRS utilisation checked:YesNo

Declaration for Missing or Unavailable Supporting Document

Document Not Available:
Return ticketOnward ticketVisa copyHotel bookingInvitation letterAdmission letterFee invoiceEmployment letterOriginal address proofOriginal cash memoRelationship proofOther:

I declare that:

  1. The transaction is genuine and is being undertaken for the stated permitted purpose.
  2. The unavailable document has not been withheld to conceal any material information.
  3. The alternative documents and explanations submitted by me are genuine.
  4. I undertake to provide the unavailable document if it becomes available or is subsequently requested.
  5. I understand that submission of this declaration does not create an automatic right to purchase or remit foreign exchange.
  6. The company may defer, restrict or decline the transaction if the available information is insufficient or inconsistent.
  7. I accept responsibility for any incorrect statement or non-disclosure.
Branch Assessment
Transaction found reasonable:YesNo
Enhanced verification completed:YesNoNot Applicable
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