Application for Remittance with Declaration (By facsimile)

To: State Bank of India, Tokyo Branch

Yurakucho Denki Building South Tower 352

7-1, Yurakucho 1-Chome Chiyodaku

Tokyo 100-0006 CPO Box No.580

FAX No. 03-3201-5750

Date:

Attn: Remittance Section

We/I hereby request you to effect the following remittance and declare the required items pursuant to Article 3 of the “Law on reporting requirements on cross border payments and receipts for the tax law compliance” as follows.

Applicant Name: 　　　 Signature:

Address:　　　　　　　　　　　　　　　　　　　　　

Tel. No. 　　　　　　　　　　　　　　　　　　　　　　　―――――――――――――――

Account No. (with SBI, Tokyo Branch) :

Mode of Remittance: Demand Draft/ Telegraphic Transfer

Amount of Remittance :

(The kind of currency to be designated :US$/INR etc)

Payee’s Name & Address :

Name of Payee’s Bank & Branch:

Account No：.

Purpose of Remittance:

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Note:

1. In case of remittance in Foreign Currencies (US$/INR etc), the exchange rate to be confirmed in advance with Remittance Section (Tel. No. 03-3284-0198). Also, in case of remittance in currencies other than INR, the name of the branch of State Bank of India to be confirmed since some selected branches are authorized to handle such remittance.

2. To cover the fund for this remittance, the fund in JPY to be remitted to State Bank of India, Tokyo Branch Current Account No.0117640 with Mizuho Bank, Yurakucho Branch by 12:00 noon for the total amount including bank charges.

3. Bank Charge

For Outward Remittances

     For issue of Demand Draft  / TTs           -JPY 4000 (all inclusive charge)

     (Yen to Dollar or Yen to Rupee) 

     For issue of Demand Draft / TTs            -JPY 6000 plus lifting charges

     (Dollar to Dollar basis)                               @ JPY 1 per US$ rounded off

                                                                            to the nearest 100

     For issue of Demand Draft  / TTs           -0.1% of the amount of remittance with a minimum of JPY 6000

(inclusive of JPY 1000 towards telex charge)

     (Yen to Yen basis) 

    Note : An additional charge of JPY 1000 towards postage will be recovered

if the draft is to be mailed by us to any destination in Japan.

For Local Remittances

     Irrespective of the amount & bank account an uniform all inclusive charge of JPY 1050 is applicable for each remittance.