Professional Documents
Culture Documents
To ensure that your payment is received by your institution without any delays, please follow the
instructions below:
Due to Indian regulations, in order to complete your payment you will need to present the attached Outward Remittance Request
Form along with proof of identity and address at a local ICICI Bank branch.
To find the nearest ICICI Bank branch, please use their branch locator by clicking Here.
1.Print the Outward Remittance Request and Payment Instructions forms
2.Fill out the Outward Remittance Request form. Note that much of the information has been pre-populated for your convenience.
Below are the items which are to be completed by the person making the INR payment (remitter). It is important that all items
below are completed in full to ensure efficient processing of your payment.
Section 1: The remitter fills in their Name, Address and Phone Number.
Section 2.b: Fill in the designated amount of INR shown on the attached instructions in words. Ensure that the amount populated
in numbers as well.
Section 3: ICICI ACCOUNT HOLDERS ONLY - The remitter provides the ICICI INR account number to be debited for the
payment. (Non-ICICI account holders see Item 4 below)
Section 5: Provide the Student Name, Student ID and Country of Study Abroad.
Section 6: Please ensure that the ICICI representative includes the displayed Reference Number with the wire payment.
Signature: The remitter signs and dates the Outward Remittance Request at the end of the Declaration on Page 3.
3.Take the printed/signed documents and present your proof of identify and address for verification by ICICI Bank*. The ICICI
representative will complete the KYC Certification with the remitter as applicable. Acceptable identification includes:
Proof Of Identity
Proof Of Address
Passport
Passport
PAN Card
Telephone bill
Voter ID Card
Electricity bill
Driving License
Government ID Card
4.Non-ICICI account holders will transfer funds locally from their respective bank accounts to ICICI Bank pool account through
NEFT/RTGS as per the details mentioned below:
Beneficiary Name: Outward Remittance Pool Account
Account Number: 0035SLORCBPC
IFSC Code: ICIC0000035
5.ICICI Bank will process your request. Western Union Business Solutions (USA), LLC will then deliver the USD payment to
your school to complete the payment.
You cannot use this sheet after this date. If the date above has passed, go online again and create a new quote. Note that there will be a small
processing fee charged by ICICI Bank.
Originating Br. ID
Track Number
Scan Br. ID
AD Code
(To be completed by the applicant in block letters using black ink pen)
Application for drawal of Foreign Exchange
I. Details of the Applicant (Remitter)
a. Name of the Applicant
b. Address (Not mandatory
for ICICI A/c holders)
Applicant Phone numbers
II. Details of Foreign Exchange required (Fill-up either II a or II b) (Ref Annex-II in page 6 for applicable
Currency Details)
II a. For remittance of fixed amount of Foreign Currency
Foreign Currency
FC
Amount In
Words
FC Amt in figures
USD
1191598.96
INR
Amount In
Words
II c. Purpose of Remittance with Purpose Code (For details refer Annexure - I in page 4)
Code
Description
Education
S1107
III. I / We authorize you to debit my / our below Account together with your charges
* Charges
borne by
beneficiary
(BEN)
* Charges
borne by
remitter
(REM)
Beneficiary Name
W
U
N
B
A
Beneficiary Address
1
W A S H
1
I
T H
S T R E E T
N G T O N
D C
N W
0
T H
L O O R
B A N K
IV c. SWIFT & SORT Code details of beneficiary Bank (In case of TT)
IBAN for remittance made to
UK, Europe, Bahrain Saudi
Arabia & UAE
Sort Code for remittance to
UK (or) BSB Code for
remittance to Australia
USBKUS44IMT
104000029
F A R N A M
O M A H A
S T
R E E T
N E B R A S K A
IV e. Furnish the following details of Correspondent Bank if the Foreign Currency is sent to a Country other than the
home Country of the Currency
SWIFT Code
V. If the purpose selected is one of the below then it is mandatory to furnish the details sought for
Maintenance
The relationship of beneficiary with the remitter (for list of close relatives refer the table given
below)
Education
The Student Name and Student ID (if any). Country of study abroad
Purchase of
Property
Investment abroad
Details
Sons Daughter
Brothers wife
Daughters Husband
Mothers Father
Father
Mothers Mother
Sons Son
Daughters Daughter
Fathers Father
Fathers Mother
Sisters Husband
Sons wife
Daughters Son
Member of HUF
VI. Furnish below if a message to be sent along with wire transfer on your behalf
US528557OU3636
INR
Declaration
I / We hereby declare that the total amount of foreign exchange purchased from or remitted through all sources in India during this Calendar /
Financial year including this application is within USD Limit as prescribed by RBI for the said purpose under FEMA 1999
(Tick the appropriate box).
<- - - - - - - - - - - - - - - - - - - - - - - - - - - -Limit Category- - - - - - - - - - - - - - - - - - - - - - - - - - - ->
Customer Category
USD
1 Lac
USD
2 Lacs
Resident Indian
NRI/PIO
a) NRE / FCNR A/c
b) NRO A/c of an NRI
c) NRO A/c of a PIO
Foreign National
a) Foreign Tourist
b) Employed in India
c) Employed In India ( not permanently
resident)
Trust / Association / Society /
Club
If Limit Category "Others" is chosen then enclose necessary support document.
USD
10 Lacs
Net
Salary
No Limit
I / We, being a person(s) resident in India, hereby declare that for transactions done under the Liberalized Remittance Scheme (LRS) for resident
individuals, issued and amended by RBI from time to time, is not in the nature of remittance for margin calls to overseas exchanges/ overseas
counter parties under this scheme.
I / We, being a person(s) resident outside India, here by declare that under Sec 4(b) of FEMA Permissible Capital A/c Transaction regulation, 2000,
the transaction mentioned above doesnt involve and is not designed for any repatriation outside India out of the proceeds of any investment in India,
in any form, in any Company, Partnership firm (or) Proprietary concern or any entity, whether incorporated or not, which is engaged or proposes to
engage
a. In the business of chit funds or
b. As Nidhi company or
c. In agricultural or plantation activity, or
d. In real estate business, or construction of farm houses (real estate business shall not include development of townships construction of
residential / commercial premises roads or bridges), or
I / We being a person(s) resident outside India, here by declare that no portion / part of outward remittance represents interest on refunds of funds
received from outside India for purchase of shares in India. Updated list of prohibited transactions under FEMA can be accessed on
ICICI Bank website www.icicibank.com
Holder
(The signature by mandate holder will be accepted only for Non resident A/c holders where mandate is duly registered with the Bank )
I certify that I have verified the Customers signature as per Bank records and retained the originals of all the scanned documents and
forms submitted by the remitter for the above transaction.
KYC Certification
(To be filled and scanned only in case of remittance by non ICICI Customer)
I met Mr./Ms./Mrs. _______________________________ at his / her residence / office / other location (specify)
________________________________ and hereby confirm the identity and address given below
1. Remitter Name
2. Remitter Address
I confirm having verified the copies of documents (as applicable) with the originals produced by the applicant.
Also I confirm that the applicant has signed the documents in my presence. List of KYC documents provided.
ID Proof
Address Proof
Date : _______________
Date : _______________
Details of INR amount credited to the pool a/c (Incl. of Charges + Service Tax) _______________________
Finacle Tran ID. _________________ IBR No. _____________________ Date of credit ______________________
into Pool A/c No.0035SLORCBPC (incase of any other a/c specify) ___________________________
(If the remittance is by way of accepting cash deposit then the amount should not exceed INR 50,000/-)