Statement D

Name of the AD Cat-I :___________________ No. of drawee branches : ___
Full Address : ____________________ Type of Account : ____________
RBI Approval No. and date : _______
Name of the Exchange House : ________________________

Particulars of operations in the Account during the month of __________
Sr.
No.
Particulars (Amount in
USD)
(Amount in
GBP)
1. Opening balance in the account (Cr/ Dr) at the start of the
month to which the statement relates
2. Total credits during the month
3. Total debits during the month
4. Closing balance (Cr/ Dr) as on--------
5. Estimated value of pipeline debits ( Average 15 days
drawings determined by progressing annual debit
summations or by item 3 above, whichever estimate is
higher )
5 (a) The amount of actual payments made by the principal
encashing branches/ offices during the last one week (for
adding to estimated pipeline)
6. Funds held abroad either as collateral by the bank or under
procedure
7. Surplus/ deficit in balance (s)/ collaterals in the account to
cover item 5
8(a) All payment advices received during the month from our paying branches have been taken into
account for raising debits in the USD/ GBP accounts of Exchange House.
(b) We confirm that the USD/ GBP accounts of Exchange Houses are conducted strictly in accordance
with the guidelines issued by RBI and in terms of the relative agreements with the Exchange Houses
concerned.
(c) Copy of the statement has been sent to the General Manager-in-Charge foreign correspondent
relationship and Department/ Office-in-Charge- Nostro account of our bank.
(d) We confirm that we have not received any adverse report/ warning signals from the General Manager
of our International Department about the Exchange House whose accounts are maintained by us at the
time of filing the statement to RBI.
________________
Chief Manager of Statement countersigned certifying that
Account Maintaining it has been internally reviewed in the
Branch bank and that the conduct is considered
satisfactory.
__________________________
Signature of the General Manager-in-Charge of International
Division/ International Operations of the AD Cat-I