Bank Copy/ ~H$ H$s {V

The Hongkong and Shanghai Banking Corporation Limited, India/

{X hmJH$mJ E|S> eKmB ~qH$J H$mnm}aoeZ {b{_Q>oS>, B{S>`m Date/{XZmH$ _____________________
Account Number/ Source of Funds and Purpose of
Name / Zm_ Amount (`)/ am{e (` ) Transaction (For Cash Deposit equivalent to
AH$mCQ> Z~a USD10,000 and above i.e. `600,000 and above)
\$S>g H$m moV Ama `dhma H$m `moOZ
(`yEgS>r 10,000 Ama A{YH$ `mZr . 600,000 Ama A{YH$
Credit Card Number/ Ho$ g_Vw` ZH$X {S>nm{OQ> Ho$ {bE)
Ho${S>Q> H$mS> Z~a
H$n`m A` WmZm| Ho$ ~H$m| Ho$ {bE AbJ \$m_ H$m BVo_mb H$a|
Please use a separate form for upcountry cheques/

Cheque Number/ MoH$ Z~a Bank/ ~H$ Branch/emIm Cash Denomination/ ZH$X No./ g.
am{e _y`dJ
{Zdmgr ~MV ImVm

` x
` x
` x
O_m \$m_
Resident Savings Account/

` x
x
DEPOSIT FORM/

`
Amount in Words/ am{e eXm| _| TOTAL DEPOSIT/
Hw$b O_m
Please indicate source of funds and purpose of transaction (For Cash deposits to Accounts only)/
For cash deposit of `50,000/- and above, accountholders PAN details/Form 60 must be updated on our records./
H$n`m \$S>g Ho$ moV Ama `dhma Ho$ `moOZ H$m gHo$V H$a| ({g\$ ImVm| _| ZH$X {S>nm{OQ>g Ho$ {bE) `50,000 Ama A{YH$ Ho$ ZH$X {S>nm{OQ> Ho$ {bE h_mao aoH$mS> _| ImVmYmaH$ Ho$ nZ {ddaU/\$m_ 60 H$mo Ad` AVZrH$V {H$`m OmZm Mm{hE&/
Valid Check/ I, state that the information declared above regarding source of funds is true and correct/ _, `h dV` XoVm /XoVr h {H$ {Z[Y`m| Ho$ moV Ho$
_m` OmM g~Y _| CnamoV Kmo{fV OmZH$mar g` Ed ghr h Please furnish the following details if cash is deposited by bearer/ ZH$X am{e `Xr YmaH$ mam mam O_m H$s JB h,
Name/ Zm_ Signature/ hVmja ________________________ Vmo {ZZ{b{IV {ddaU ^ao&

DEPOSIT SLIP_04/15
Note/ ZmoQ> 1. Local cheques etc. although passed to the credit of your account are accepted for collection only and will not be available for withdrawl until cleared/ Bearers Name/ YmaH$ H$m Zm_ _________________________________________
WmZr` Mog B`m{X hmbm{H$ H$boeZ Ho$ {bE drH$ma {H$E OmZo na AmnHo$ AH$mCQ> _| Ho${S>Q> Ho$ nmg {H$E OmVo h, bo{H$Z CZHo$ pb`a hmoZo VH$ CZH$mo {ZH$mbm Zht Om gHo$Jm
Signature/ hVmja _________________________________________
2. Funds available date is shown for indicatory purpose only/ \$S>g H$s CnbY {V{W Ho$db gHo$V hoVw h&
3. Receipts issued by this bank are governed by terms set out or notices on display in bank branches/
Bg ~H$ mam Omar agrX| {ZYm[aV eVm] `m ~H$ H$s emImAm| _| X{eV H$s JB gyMZmAm| mam em{gV h& Bearers address and telephone number/
4. The Bank may enquire about details of source of funds and purpose of transaction for transaction value lower than the one indicated above / YmaH$ H$m nVm VWm \$moZ Z.:____________________________________________
~H$ D$na {ZX}{eV am{e go H$_Va _y` Ho$ `dhma Ho$ {bE \$S>g Ho$ moV Ama `dhma Ho$ `moOZ Ho$ {ddaUm| Ho$ ~mao _| nyN>VmN> H$a gH$Vm h
5. An Indicative Conversion Rate: 1 USD = `60 / EH$ gmHo${VH$ $nmVaU Xa : 1 `yEgS>r = `60
English - Hindi
 Bank Copy/ ~H$ H$s {V
The Hongkong and Shanghai Banking Corporation Limited, India/
{X hmJH$mJ E|S> eKmB ~qH$J H$mnm}aoeZ {b{_Q>oS>, B{S>`m Date/{XZmH$ _____________________
Account Number/ Source of Funds and Purpose of
Name / Zm_ Amount (`)/ am{e (` ) Transaction (For Cash Deposit equivalent to
AH$mCQ> Z~a USD10,000 and above i.e. `600,000 and above)
\$S>g H$m moV Ama `dhma H$m `moOZ
(`yEgS>r 10,000 Ama A{YH$ `mZr . 600,000 Ama A{YH$
Credit Card Number/ Ho$ g_Vw` ZH$X {S>nm{OQ> Ho$ {bE)
Ho${S>Q> H$mS> Z~a
H$n`m A` WmZm| Ho$ ~H$m| Ho$ {bE AbJ \$m_ H$m BVo_mb H$a|
Please use a separate form for upcountry cheques/

Cheque Number/ MoH$ Z~a Bank/ ~H$ Branch/emIm Cash Denomination/ ZH$X No./ g.
am{e _y`dJ
{Zdmgr ~MV ImVm

` x
` x
` x
O_m \$m_
Resident Savings Account/

` x
x
DEPOSIT FORM/

`
Amount in Words/ am{e eXm| _| TOTAL DEPOSIT/
Hw$b O_m
Please indicate source of funds and purpose of transaction (For Cash deposits to Accounts only)/
For cash deposit of `50,000/- and above, accountholders PAN details/Form 60 must be updated on our records./
H$n`m \$S>g Ho$ moV Ama `dhma Ho$ `moOZ H$m gHo$V H$a| ({g\$ ImVm| _| ZH$X {S>nm{OQ>g Ho$ {bE) `50,000 Ama A{YH$ Ho$ ZH$X {S>nm{OQ> Ho$ {bE h_mao aoH$mS> _| ImVmYmaH$ Ho$ nZ {ddaU/\$m_ 60 H$mo Ad` AVZrH$V {H$`m OmZm Mm{hE&/
Valid Check/ I, state that the information declared above regarding source of funds is true and correct/ _, `h dV` XoVm /XoVr h {H$ {Z[Y`m| Ho$ moV Ho$
_m` OmM g~Y _| CnamoV Kmo{fV OmZH$mar g` Ed ghr h Please furnish the following details if cash is deposited by bearer/ ZH$X am{e `Xr YmaH$ mam mam O_m H$s JB h,
Name/ Zm_ Signature/ hVmja ________________________ Vmo {ZZ{b{IV {ddaU ^ao&

DEPOSIT SLIP_04/15
Note/ ZmoQ> 1. Local cheques etc. although passed to the credit of your account are accepted for collection only and will not be available for withdrawl until cleared/ Bearers Name/ YmaH$ H$m Zm_ _________________________________________
WmZr` Mog B`m{X hmbm{H$ H$boeZ Ho$ {bE drH$ma {H$E OmZo na AmnHo$ AH$mCQ> _| Ho${S>Q> Ho$ nmg {H$E OmVo h, bo{H$Z CZHo$ pb`a hmoZo VH$ CZH$mo {ZH$mbm Zht Om gHo$Jm
Signature/ hVmja _________________________________________
2. Funds available date is shown for indicatory purpose only/ \$S>g H$s CnbY {V{W Ho$db gHo$V hoVw h&
3. Receipts issued by this bank are governed by terms set out or notices on display in bank branches/
Bg ~H$ mam Omar agrX| {ZYm[aV eVm] `m ~H$ H$s emImAm| _| X{eV H$s JB gyMZmAm| mam em{gV h& Bearers address and telephone number/
4. The Bank may enquire about details of source of funds and purpose of transaction for transaction value lower than the one indicated above / YmaH$ H$m nVm VWm \$moZ Z.:____________________________________________
~H$ D$na {ZX}{eV am{e go H$_Va _y` Ho$ `dhma Ho$ {bE \$S>g Ho$ moV Ama `dhma Ho$ `moOZ Ho$ {ddaUm| Ho$ ~mao _| nyN>VmN> H$a gH$Vm h
5. An Indicative Conversion Rate: 1 USD = `60 / EH$ gmHo${VH$ $nmVaU Xa : 1 `yEgS>r = `60
English - Hindi