Authorisation for Collection of Foreign Currency by Representative — Declaration Format

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Date:

Transaction Reference No.:

Traveller Details

Name:

Passport No.:

PAN:

Travel Date:

Foreign Currency and Amount:

Representative Details

Name:

Relationship with Traveller:

ID Type:

ID No.:

Mobile No.:

Address:

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:

The representative is personally known to me.
The representative is authorised only to collect the foreign exchange and related documents and is not authorised to alter the transaction particulars.
I have independently verified the currency, amount, rate, charges and transaction details.
I accept responsibility for the foreign exchange once it has been delivered to the authorised representative.
I authorise the company to obtain the representative’s photograph, identity proof, signature and delivery acknowledgement.
I understand that the company may refuse delivery where the representative’s identity or authority cannot be satisfactorily established.

Traveller’s Signature

Representative’s Signature

Delivery Acknowledgement

I acknowledge receipt of:

Currency:

Amount:

Cash Memo / Card No.:

Date and Time of Delivery:

Representative’s Signature at Delivery

For Office Use

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

Delivered by:

Authorised Signatory: