The document is an application from a company in Panipat, India to Axis Bank for remittance against a direct import bill of USD 19826 to Star Textiles and Garments in Sharjah, UAE. It provides details of the beneficiary such as name, address, account and IBAN numbers. It also specifies the beneficiary bank, purpose of payment as import bill, and a request to debit INR and USD accounts for the transaction amount and charges. Declarations are made that the imported goods are not restricted or involve contravention of foreign exchange laws and regulations. Required documents like A1 form, invoice copy, bill of lading/airway bill, and bill of entry numbers are enclosed.

1. The Branch Head,
AXIS Bank Ltd.
PANIPAT Branch
Dear Sir,
Sub: Application for Remittance against Direct Import Bill.
Currency & Amount Beneficiary Name, Address & Account No. / IBAN.
USD-19826.00
STAR TEXTILES AND GARMENTS (FZE)
P.O. BOX 9010, SAIF ZONE, SHARJAH U.A.E.
IBAN NO. : AE92023000001001493467
Account No. : 1001493467
Beneficiary Bank Name, Address & SWIFT / Sort Code Purpose
COMMERICIAL BANK OF DUBAI
BRANCH- SHARJAH, U.A.E.
SWIFT CODE : CBDUAEAD
IMPORT BILL PAYMENT
Foreign Bank Charges OUR / BEN / SHA
We would like to purchase / utilise forward contract no._______________ and remit (Foreign Currency & Amount) USD-
19826.00 as above.
We enclose herewith a copy of the Invoice No. _____________________, B/L / AWB No.________________ received by us directly.
The required A1 form, duly filled in and Exchange Control Copy of Bill of Entry No.1. 5375939 DATED 24/05/2016 2.
5289615 DATED 17/05/2016 3. 5335419 DATED 20/05/2016 in support of the said remittance are enclosed.
We request you to debit my/ our EEFC / RFC Account No.__________________________ for USD-19826.00 and the balance
amount to my/ our INR Account No.916020008969169 along with your charges.
DECLARATION – CUM – UNDERTAKING
The goods imported/being imported by us are not covered under Negative list of imports as mentioned in Export import policy 2009-
2014 and amendments there to till date.
We are eligible to import the above- mentioned goods under the current Export and Import Policy in Place.
The said goods imported/being imported by us are not restricted for import through specific licensing under the above-mentioned
policy and amendments.
I/We declare that the captioned transaction does not involve and is not designed for the purpose of any contravention or evasion of
the provision of the Foreign Exchange management Act 1999 or any rule, regulations, notification, direction or order issued there
under.
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. 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 Reserve Bank of India.
In this regard, we confirm that the HS Code of the goods is 63109040 and mutilation conform to the requirement specified by
Customs Public Notice or Trade Notice.
We are unable to submit BOEs of these shipments as goods are not released from Custom and we confirm to submit
Bill of Entries within three months from transaction date.
*I/We further declare that the undersigned has the authority to give this application, declaration and undertaking on behalf of
the firm/company.
Thanking you.
Yours faithfully,
Date :
Place : PANIPAT
Signature: ______________________________
Name: ______________________________
Address: ______________________________
I.E. Code: ______________________________
Encl.: A1, Copy of Invoice, B/L/AWB, Bill of Entry etc