Bank
of India
NEW
YORK BRANCH
277,
PARK AVENUE,
NEW
YORK, N.Y. 10172-0083
TEL:
(212) 753-6100
TOLL
FREE 1-800-232-2828
IT
IS SUGGESTED THAT DEMAND DRAFTS BE MAILED BY
REGISTERED MAIL IN YOUR OWN INTEREST
APPLICATION
FOR REMITTANCE
" This Is Only
An Application Form And Does Not Constitute An Instruction For
Payment"
PAY
TO (PLEASE PRINT)
REMITTAR
(PLEASE PRINT)
NAME
:
ADDRESS
: (IF OTHER THAN DRAFT)
.
.
.
.
CITY
:
COUNTRY
:
SPECIAL
INSTRUCTIONS IF ANY
(
FOR TRASFER BY CABLE OR MAIL ONLY)
.
.
.
.
NAME
:
ADDRESS
: (IF OTHER THAN DRAFT)
.
.
.
CITY
:
STATE
:
ZIP:
TELEPHONE:
S.S.N0.:
U.S
Dollars
CHECK
________
___
CASH
________
___
TOTAL
________
___
NAME
OF THE BRANCH
RATE
RUPEE
AMOUNT
U.S
DOLLARS
AMOUNT
________
___
I
have read the bank's rules and regulations governing the
issuance of remittances as contained on the reverse of this
application form and hereby agree to be bound by them
