Hsbc Fund Transfer Form – Fill Out and Use This PDF

OUTWARD TELEGRAPHIC TRANSFER/DEMAND DRAFT/

LIBERALISED

REMITTANCEAPPLICATIONSCHEMECUM FORM(LRS)A2

Date:

56A

Intermediary bank

Name:

Optional - for

Address:

routing payment

to beneficiary

Bank

Country:

Swift Code/Chips ID/Australia BSB Code/USA Fed Wire/USA ABA/

UK Sort Code/UID no.:

57

Beneficiary’s bank

Beneficiary bank’s Name:

Address:

Country:

Please fill up any of the following (as applicable):

For USD payment:

For Euro payment:

in USA

Fedwire No.:

in UK

Sort Code:

outside USA

outside UK

Swift Code:

Swift Code:

For GBP payment:

For AUD:

in UK

Sort Code:

in Australia

BSB Code:

outside USA

Swift Code:

Swift Code:

For any other currencies:

outside Australia Swift Code:

in any country Swift Code:

Customer’s signature

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59 Beneficiary	Name of beneficiary:
	Residential status of beneficiary:		Resident	Non-resident

Student name and ID (in case of payment to university):

Address:

Account number: (Required only when the remittance is to be directly credited to the Bank account of the beneficiary)

Country:

IBAN (mandatory for payment in UK, Europe, Jordan, Qatar and UAE) :

	Sr. No.	Whether under LRS (Yes/No)	Purpose Code	Description

As per the purpose code mentioned below:

Remitter should select the appropriate purpose code. In case of doubt/difficulty, please consult the Bank.

Please select the appropriate purpose code

For the complete list of purpose codes, please refer to the ‘RBI purpose codes for Forex transactions’ on our website www.hsbc.co.in

If payment is for import of services (Purpose Group Nos. 02, 03, 05, 06, 07, 08, 09, 10, 11, 15, 16 or 17), please indicate:

Name of the country providing ultimate services:

71

All local and overseas charges

OR

All local and overseas charges

OR

Local charges to be borne by remitter

to be borne by beneficiary (BEN)

to be borne by remitter (OUR)

and overseas charges by beneficiary (SHA)

72

Bank to bank information (if any):

Ordering Party Details

Is this payment on behalf of a third party?

Yes

No (If so, please provide details of the ordering party)

Account Identifier:

Full Name:

Full Address:

Country/Territory:

We authorise the Bank to debit the sum of amount for the lawful purpose detailed above and agree to abide by the terms and conditions printed below:

Signature verified by __________________________________________________________

(Name of the staff with ID)

Customer’s signature

Terms and Conditions

In requesting the Bank to make the Telegraphic Transfer/Demand Draft, I/we hereby agree that it is to be despatched in accordance with the following conditions:

•FEMA declaration needs to be signed compulsorily

•In the absence of specific instructions to the contrary, the Telegraphic Transfer/Demand Draft will be effected in the currency of the country in which payment is to be made

•All charges/commission incurred outside India are for the beneficiary’s account unless specified

•The Bank reserves the right to draw this Telegraphic Transfer/Demand Draft on a different place from that specified by the remitter if operational circumstances so require

•Telegraphic Transfer is to be dispatched entirely at the remitter’s own risk and for a Demand Draft, the Bank will not be responsible for mail service failure if it is dispatched on behalf of the customer

•Where the Bank is unable to provide a firm exchange rate quotation, the Bank shall effect the remittance on the basis ofa provisional exchange rate which shall be subject to adjustment when the actual exchange rate is ascertained. Any difference between the provisional rate and the actual rate shall be debited/credited (as the case may be) to the applicant’s account

•The Bank is at liberty to send the Telegraphic Transfer either literally or in cipher and the Bank accepts no responsibility for any loss, delay, error, omission or mutilation which may occur in the transmission of any message or for its misinterpretation when received

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•Applications received will be processed on the availability of market rates and applications for same day value are subject to cut-off times related to the geographical location of the destination

•Encashment of the remittance is subject to any exchange control or restrictions which may be imposed by the rules and regulations of the country where encashment is to be made. Neither the Bank nor its correspondents shall be liable for any loss or delay caused by any suchrules and regulations

•The Bank reserves the right to revise all Telegraphic Transfer charges from time to time without prior notice

•Please note that the Bank does not extend any kind of credit facilities to resident individuals to facilitate remittances under the Liberalised Remittance Scheme (LRS). Therefore utilising the proceeds of loan amount towards facilitating remittances under the LRS is prohibited. (Applicable for remittance under LRS)

•In case the residential status of the beneficiary is 'resident' remittance under the LRS cannot be effected

•Effective 7 March 2015, for all Funds Transfer requests of Value greater than 200,000, a cancelled cheque of the account from which the transaction is being carried out will be required to be submitted additionally, along with the requisite documentation

•NRIs/PIOs, on submission of documentary evidence, can remit up to USD one million, per financial year out of balances in their Non-Resident Ordinary (NRO) accounts from proceeds through sale of assets acquired in India by way of inheritance or legacy. However the said remittance should be made out of the remitter's balances held in the NRO account arising from his/her legitimate receivables in India and not by borrowing from any other person or a transfer from any other NRO account. You are requested to provide a declaration for the same. Do note that non adherence of the said guideline will render yourself liable for penal action under the Foreign Exchange Management Act (FEMA).

*Declaration (Under FEMA 1999)

1)I, _________________________________________________________________________________________ hereby declare that the total amount of foreign exchange

purchased from or remitted through all sources in India (either in an individual capacity or in the capacity as a sole proprietor or both put together) during the

financial year including this remittance, loan extended or gift made in rupees credited to NRO account of non-resident close relative(s) (as defined under Section 6 of Company Act 1956), is within the overall limit of the Liberalised Remittance Scheme as prescribed by the Reserve Bank of India and certify that the sources of funds for making the said remittance belong to me and the foreign exchange will not be used for prohibited purposes.

Details of the remittances made/transactions effected under the Liberalised Remittance Scheme in the current financial year (April - March)

2) I, __________________________________________________________________________________________________________________________

The total amount of foreign exchange purchased from or remitted through, all sources in India during this financial year (as applicable)

including this application is within USD

(USD

_________________________________________________________________________________________________________________ only) the

annual limit prescribed by Reserve Bank of India for the said purpose.

Foreign exchange purchased from you is for the purpose indicated above. (Strike out whichever is not applicable)

Signature of the applicant		Signature of the natural guardian of the applicant@
Name		Name

@Where the applicant is minor, the application should be signed by minor’s natural guardian.

Date:

Certificate by the Authorised Dealer

This is to certify that the remittance is not being made by/to ineligible entities and that the remittance is in conformity with the instructions issued by the Reserve Bank from time to time under the Scheme.

Name of the authorised official:

Designation of the authorised official:

Place:

Date:

Stamp and Seal

Signature

For delivery of Demand Drafts

Please deliver the Demand Draft to bearer Mr./Mrs.

whose signature is appended below:

I hereby acknowledge receipt of the Demand Draft

(Signature of the bearer)

(Signature of the remitter)

(Signature of the bearer)

For office use only

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