Name of the FFMC/ AD Cat-II :

Statement of the amount of foreign currency written off during the financial year ended______________

A. Total amount written-off (in equivalent USD) :-
B. Details of the amount written-off :-
Sr. No. Date of write-off
Amount of
foreign currency (with currency-wise break-up)
On account of *
Approved by
FFMC/AD Cat-II/ Reserve
Bank
1. 2. 3. 4. 5.
Total :
* Please indicate whether on account of being found to be fake or forged/ theft/ lost in transit, etc.