Report by the Indian company receiving amount of consideration for issue of shares / Convertible debentures under the FDI Scheme

( To be filed by the company through its Authorised Dealer Category – I bank, with the Regional Office of the Reserve Bank under whose jurisdiction the Registered Office of the company making the declaration is situated, not later than 30 days from the date of receipt of the amount of consideration, as specified in para 9 (I) (A) of Schedule I to Notification No. FEMA 20/2000- RB dated May 3, 2000 )
Permanent Account Number (PAN) of the investee company given by the IT Department No.
Particulars
(In Block Letters)
Name of the Indian company
Address of the Registered Office
Fax
Telephone
1.
e-mail
Details of the foreign investor/ collaborator
2
Name
Address
Country
3.
Date of receipt of funds
4.
Amount
In foreign currency
In Indian Rupees
5.
Whether investment is under Automatic Route or Approval Route
If Approval Route, give details (ref. no. of approval and date)
Automatic Route / Approval Route
6.
Name of the AD through whom the remittance is received
7.
Address of the AD
A Copy of the FIRC evidencing the receipt of consideration for issue of shares/ convertible debentures as above is enclosed.
(Authorised signatory of
the investee company)
(Stamp)
(Authorised signatory of
the AD)
(Stamp)
FOR USE OF THE RESERVE BANK ONLY:
Unique Identification Number for the remittance received:
Know Your Customer (KYC) Form in respect of the non-resident investor
Registered Name of the Remitter / Investor
(Name, if the investor is an Individual)
Registration Number (Unique Identification Number* in case remitter is an Individual)
Registered Address (Permanent Address if remitter Individual)
Name of the Remitter’s Bank
Remitter’s Bank Account No.
Period of banking relationship with the remitter
* Passport No., Social Security No, or any Unique No. certifying the bonafides of the remitter
as prevalent in the remitter’s country
We confirm that all the information furnished above is true and accurate as provided by the overseas remitting bank of the non-resident investor.
(Signature of the Authorised Official
of the AD bank receiving the remittance)
Date : Place:
Stamp :