I / We hereby declare that -
Declaration under FEMA 10 (5)
1. I / We hereby declare that the transaction details of which are mentioned above does not involve, and is not designed for the purpose of any contravention or evasion of the provisions
of the aforesaid Act, or of any rule, regulation, notification, direction or order made there under.
2. I / We also understand that if I / we refuse to comply with any such requirement or make only unsatisfactory compliance therewith, the Bank shall refuse, in writing, to undertake the
transaction and shall, if it has reason to believe that any contravention / evasion is contemplated by me / us, report the matter to RBI.
3. I / We also hereby agree and undertake to give such information / documents as will reasonably satisfy you about this transaction, in terms of the above declaration.
Declaration under Liberalised Remittance Scheme
1. The total amount of foreign exchange purchased from or remitted through, all sources in India, during this financial year including this application is within USD 2,50,000 (USD Two Lakh
Fifty Thousand only) the annual limit prescribed by Reserve Bank of India for the said purpose indicated in this Application Form.
2. I / We hereby certify that the source of funds for making the said remittance belongs to me and the foreign exchange will not be used for prohibited purposes.
3. I am a person resident in India. I am not a Foreign National / NRI / PIO.
4. I have not availed any loan / credit / borrowings for remitting under Liberalised Remittance Scheme for Capital Account transactions.
5. I / We undertake to make all Capital A/c transactions under LRS from Axis Bank only. Also, I / We have not clubbed remittance amount with any of my / our family members.
6. I / We confirm that if the remittance is being made for travel arrangements of Resident Individuals, as per enclosed list, the remittance made is within the limits prescribed by the Reserve
Bank of India for the resident individuals under the Liberalised Remittance Scheme and where the remittance is being made for Foreign tourists, as per enclosed list, the amount of
remittance does not exceed the amount of foreign exchange remitted to India by the foreign tourists. (Applicable for Tour Operator Remittances Only)
Declaration for Remittance of Life Insurance Premium by Residents in India
I / We declare that the conditions mentioned hereunder are compiled in respect of remittance towards premium on life insurance policy (as enclosed) issued in foreign currency;
1. I am a resident person of Indian nationality / origin who have returned to India after being Non-Resident and the premium is being paid out of remittances from foreign currency funds
held by me abroad or from my Resident Foreign Currency (RFC) account in India OR I am a foreign national not permanently resident in India and the premium is paid out of foreign
currency funds or from my income earned in India or repatriable superannuation / pension fund in India.
2. The transaction does not involve conversion of Rupee policies on the lives of person resident in India into foreign currency or transfer of records of such policies to a country outside India.
OFAC Declaration
1. I / We undertake not to hold Axis Bank Ltd., responsible for in any manner whatsoever in nature and hold Axis Bank Ltd., fully indemnified against all losses and damages that may be
caused to me on account of the funds remitted under this transaction being confiscated or blocked or seized by any authority / government / agency. I also undertake to bear the risk of
currency or cross currency, if any, in case Axis Bank needs to convert the remittance amount to any other currency or vice-versa or whatsoever in nature.
2. I / We further declare that I shall furnish any material information relating to this transaction as required by any authority / government / agency, now or in future. I / We also authorize
Axis Bank Ltd., to make available any of the material information pertaining to my / our transaction to any authority / agency / entity without referring the matter to me / us.
Declaration for FX Retail Customers
I have read and understood the Terms and Conditions regarding the FX Retail Service available at www.fxretail.co.in and hereby agree to abide by them. I undertake to provide further
information required by Axis Bank in this regard and execute any further documents as may be required. I understand and consent to the fact that Axis Bank reserves the right to refuse any
application without providing a reason therein. I am also aware that Axis Bank shall not be liable for any loss/risk which may arise on account of the transactions executed using this Service.
I understand that the limit and the margin on the FX-Retail platform will be set as per the sole discretion of the bank.
I agree that the Bank is at complete and sole liberty to debit my Bank Account mentioned hereinabove or any of my other accounts for the sum that is owed by me to the Bank, towards
registration charges and charges arising out of any loss caused / suffered by the Bank due to reversal or modification of transaction rate by me. The Bank shall have the right to debit my said
account held with the Bank or any of my other accounts for the aforesaid amounts and I hereby irrevocably and unconditionally undertake, agree and authorize the Bank to debit my accounts
forthwith without protest, delay or demur and without proof or condition the whole of such sum debited together with interest, charges, expenses due to the Bank and undertake to keep the
Bank protected against all losses of the said principal sum, interest, dues and all costs charges and expenses and I shall not contest the decision of the Bank on any grounds whatsoever. I
undertake that I shall at all times keep the account/s funded with sufficient funds to enable the Bank to debit the account/s to recover the aforesaid dues / charges. I hereby further confirm
that the said provision is irrevocable and unconditional.
At first instance if any difference, dispute or question shall arise between the Bank and me as to the interpretation, meaning or effect of this application or as to the rights and liabilities of the
Bank and me arising hereunder or as to any other matter or things relating to this application or arising out of or in connection herewith either during the continuance of this application or
after any termination or purported termination hereof, I agree that the same shall be referred to a sole Arbitrator who shall be appointed by mutual agreement sand whose decision shall be
final and binding. I agree that the said arbitration shall be governed by the provisions of Arbitration & Conciliation Act, 1996 or any statutory modification or re-enactment thereof and the
venue of the Arbitration shall be Mumbai. I further agree that the language to be used in the arbitral proceedings shall be English.
General Declarations
1. The purpose and transaction details as mentioned above are true to the best of my knowledge and I / We shall be responsible and liable for any incorrect detail provided by me / us.
2. The remittance is not being requested for any purpose specifically prohibited under Schedule I or any item restricted under Schedule II of Foreign Exchange Management (Current Account
Transaction) Rules, 2000.
3. The remittance is not being sent directly or indirectly to those individuals and entities identified as posing significant risk of committing acts of terrorism as advised separately by the RBI
to the banks.
4. I / We confirm that the beneficiary is a Non Resident Indian where the purpose of the remittance is for “Family Maintenance and Savings” or towards “Personal gifts and donations”.
5. I / We agree that submission of request does not necessarily imply processing of the transaction. Axis Bank has full rights to reject the transaction based on regulatory and internal
guidelines. I / We agree that in the event the transaction could not be executed / debited to my / our account, after submitting the request for processing to the bank on account of
insufficient / unclear balance at the time of execution of the transaction in my / our account, Axis Bank shall not be responsible for not being able to process the transaction. Any exchange
losses incurred in this connection, due to reversal of the forex deal, can be charged to me or my / our Axis Bank account.
6. I / We agree that in the event the transaction is cancelled or revoked by me / us after submitting the request for processing to the bank, any exchange losses incurred in this connection,
can be charged to me or my / our Axis Bank account. I / We agree that in the event the transaction being rejected by the beneficiary bank, because of incorrect information submitted by
me, any charges levied by the beneficiary bank or exchange losses incurred in this connection can be charged to me or my / our Axis Bank account.
7. I / We further agree that once the funds remitted by me / us have been transmitted by Axis Bank to the correspondent and / or beneficiary banks, Axis Bank shall not be responsible for
any delays in the disbursement of such funds, including the withholding of such funds by the correspondent and / or beneficiary banks.
8. I / We agree that once the funds remitted by me / us have been transmitted by Axis Bank, intermediary bank charges may be levied by correspondent and / or beneficiary banks, which
may vary from bank to bank
9. I / We further declare that the undersigned has the authority to give this application, declaration and undertaking on behalf of the firm / company. Applicable when the application /
declaration / undertaking is signed on behalf of the firm / company.
10. I agree / confirm that the remittance will be processed at the applicable card rate on the date of transaction and the applicable commission / fees be levied in addition to the applicable
statutory levies / duties / taxes.
11. I / We aware of bank policy on customer compensation and grievance redressal as available on Axis Bank's website.
12. I / We confirm that remittance is not for margins or margin calls to overseas exchanges / overseas counterparty.
13. I / We confirm that remittance is not for purchase of FCCBs issued by Indian companies in the overseas secondary market.
14. I / We confirm that remittance is not for trading in foreign exchange abroad.
Version Number RFR/23-24/3