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/EEFC A/c. No. together with their charges and * * * * Issue foreign currency notes for : Amount (specify currency) : *(Strike out whichever is not applicable) for the purpose/s indicated below. Whether under LRS (Yes/No) As per the Annex Remitter should put a tick ( ) against an appropriate purpose code. In case of doubt/ difficulty, the AD bank should be consulted. VER 1.5/FORM A2/WPC/03-16 I, (Name), hereby declare that the total amount of foreign exchange purchased from or remit.

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