Name of the Company

 

 

 

 

 

 

 

 

 

 

Sr.

Name and Address

Nationality

Origin

Value

Amount

Mode of

Bank

No.

of investors

 

 

of CP

received

Receipt

Certi-

 

 

 

 

 

(State

(By direct

ficate

 

 

 

 

issued

currency)

remittance

Number

 

 

 

 

(Rs.)

 

or by

and date

 

 

 

 

 

 

debit

 

 

 

 

 

 

 

NRE/FCNR/

 

 

 

 

 

 

 

NRO

 

 

 

 

 

 

 

account)

 

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

We hereby certify that the particulars given above are true and correct to the best of our

knowledge and belief and in accordance with the terms and conditions stipulated in Reserve

Bank (IECD) approval No.

 

dated

.

Date:

 

 

 

(Signature of Authorised Official)

 

 

 

 

Name:

 

 

Stamp

 

Designation

 

 

 

 

Name & Address

 

 

 

 

of the company

 

 

 

 

 

 

NOTE:

To be countersigned by the banker (authorised dealer) to whom approval letter has

 

been issued by RBI (IECD)