Statement A

Name of the Authorized Dealer Cat-I :
Full address :
Name of Exchange House :

Particulars of operations in the account in the month of

1. Opening balance in the account (Cr/Dr) at the start of _________ : _____________
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 progressive
annual debit summations or by item No.3 above,
whichever estimate is higher)
5a. 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 as collateral by the bank or under :__________________
DDA procedure.
7. Surplus /deficit in balances/collaterals in the account to :__________________
cover item No.5
8. State amount of counter-value foreign currency : Date Amount of Amount recovered
from the Exchange House against each specific of foreign credit afforded to the account during
the month currency corresponding to the sale of rupees made by the bank recovered to the
Exchange House
A) All payment advices received during the month from our paying branches have been taken
into account for raising debits in the rupee accounts of the Exchange House.
B) We have received confirmation from our Nostro account maintaining banks abroad for
having credited counter value (foreign currency) funds to our Nostro account before crediting
rupee funds to the account of the Exchange House.
C) We confirm that the rupee accounts of the 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.
D) Copy of the statement has been sent to the General Manager-in-charge, Foreign
correspondent relationship and department / Officer in Charge, Nostro Account of our bank.
E) We confirm that we have not received any adverse report / warning signals from the
General Manager of our International Department whose accounts are maintained by us at
the time of submitting the statement.
Statement countersigned by certifying that it has
been internally reviewed in the bank and the
conduct of the account is considered
satisfactory.
_________________________ ______________________________
Chief Manager of the Account Signature of the General Manager – in-Charge of
Maintaining Branch International Division /International Operations in the bank.