V-4
1
APP. V 4 NAME OF THE BANK........................................................ APPLICATION FOR PAYMENT OF SUBSIDY ON FOREIGN CURRENCY TERM/FIXED DEPOSITS FROM MATURITIES ABOVE THREE (3) MONTHS S. No. Account No. Date of Deposit Reference No. of the Statement in App. V-3 and S. No. of the item Statement No. Item No. Forward Contract Number Amount of deposit in foreign currency Period of deposit with maturity date Rate of interest payable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Rate applicable for payment of subsidy Total amount in foreign currency at the rate given in Column 9 Rate of return last allowed on such Rupee PLS Accounts Interest amount in foreign currency at the domestic rate given in Column 11 Amount of subsidy in foreign currency (10 - 12) Rupee equivalent of the amount of subisdy Exchange Rate Amount It is certified that the interest amount on the above deposits for their full term has been paid/credited to the Account-holder. (Authorised Signature)
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APP. V 4
NAME OF THE BANK........................................................
APPLICATION FOR PAYMENT OF SUBSIDY ON FOREIGN CURRENCY TERM/FIXEDDEPOSITS FROM MATURITIES ABOVE THREE (3) MONTHS
S. No. Account No. Date of DepositReference No. of the
Statement in App. V-3and S. No. of the item
Statement No. Item No.
ForwardContractNumber
Amount ofdeposit inforeign
currency
Period ofdeposit
withmaturity date
Rate ofinterestpayable
1 2 3 4 5 6 7 8
9 10 11 12 13 14
Rate applicablefor paymentof subsidy
Total amount inforeign currencyat the rate given
in Column 9
Rate of returnlast allowed on
such Rupee PLSAccounts
Interest amount inforeign currency atthe domestic rate
given in Column 11
Amount ofsubsidy in
foreigncurrency(10 - 12)
Rupee equivalent of the amountof subisdy
Exchange Rate Amount
It is certified that the interest amount on the above deposits for their full term has been paid/credited to the Account-holder.
(Authorised Signature)
