Statement showing summation of Foreign Currency Account opened out of export proceeds of Foreign Currency Notes/ encashed Travellers Cheques for the quarter ended ___________

(Value in USD)
Opening Balance in the Account
Value of foreign currency notes/ encashed TCs exported
Amount realized in foreign currency Of Column 3 amount credited to
Foreign Currency
Account Amount remitted to TC issuing organization from TCs sold/
Debited for purchase of foreign currency notes from ADs
Maximum balance maintained on any day in the foreign currency account during the quarter
Closing balance in the Foreign
Currency Account
Remarks
1. 2. 3. 4. 5. 6. 7. 8.
Certified that the above particulars are correct as per our records.
Name and address of the AD Cat-I
Signature of Authorized Official of the AD Cat-I with Seal