yHkpH (u) FORM(A)

oGif;ukefrSty tjcm;udpötwGuf EdkifiHjcm;okH;aiG vJTcGifhavQmufvTm

APPLICATION FOR FOREIGN EXCHANGE REMITTANCES OTHER THAN FOR IMPORTS

atmufwGifazmfjyxm;aom udpötwGufEdkifiHjcm;oHk ;aiG 0,f,l/vJTykdY cGifhjyKyg&ef uRefawmf(rsm;) avQmufxm; yg onf/ I/We apply for purchase/remit of foreign exchange for the purpose state below:-

(1) jynfyc&D;oGm;&eftwGuf ukefusp&dwf /

For Travel Expenses abroad (2) ynmoifp&dwf /

Educational Expenses (3) toif;0if;aMu; /

Membership fees (4) aq;ukop&dwf /

Medical Expenses (5) tjcm;udpö /

Other purposes uGsefawmf (rsm;) onf atmufygEkdifiHjcm;aiG trsKd;tpm;ukd 0,f,l/vJTykdY vkdygonf/

I/We wish to purchase/remit the following type of foreign currency.

aiGtrsdK;trnf

( Name of Currency)

____________________ ____________________

aiGta&twGuf ( *Pef;jzifh ) aiGta&twGuf (pmjzifh)

( Amount in Figures) ( Amount in words )

EkdifiHom;pdppfa&;u'fjym;trSwf/EkdifiHjcm;om;_____________ rSwfykHwiftrSwf _________________

NRC/FRC No.______________ EkdifiHom; ______________ Nationalityxkwfay;onfhaeYpGJ ______________

Date of lussueae&yfvdyfpm___________

Address

cGifhjyKaiG

AMOUNT APPROVED

uarÇmZbPfvDrdwuf

KANBAWZABANK LIMITED rSwfcsuf// cGifhjyKonfhaeYrS wpfvtwGif;om 0,f,lcGifh&Sdonf/

NOTE-Valid fo r one month only from the date of approval.

avQmufxm;oltrnfESifhvufrSwf Name and signature of Applicant

0efcHcsuf

(u) uGsefawmf (rsm;) onf wpfzufwGif avQmufxm;aom EkdifiHjcm;okH;aiGteuf cGifhjyKaomaiGukdcGifhjyKonfh

udpö&yf twGufomvsif trSefokH;pGJrnf[k 0efcHygonf /

(c) uGsefawmf (rsm;) onf 0,f,lcGifhjyKonfh EkdifiHjcm;okH;aiG teufrS okH;pGJjcif; rjyKcJh&ao;aom aiG&Sdygvsif

xkdaiGukdjrefrmEkdifiHokdY jyefvnf,laqmifvmjyD; uGsefawmf(rsm;)jyefvnfa&mufvmonfh tcgwGif EkdifiHjcm;

aiGvJvS,frI pnf;rsOf;owfrSwfa&; tufOya'yg jyXmef;csufrsm;ESifh tufOya't& xkwfjyefxm;aom

enf;Oya'rsm;? nTefMum;csufrsm;?okdYr[kwf trdefYrsm;ESifhtnDrSefuefpGmaMujimazmfjyí jrefrmEkdifiHawmf

A[kdbPf okdY tjrefqkH;ay;tyfygrnf [k0efcHygonf/

aeYpGJ___________ ________________ avQmufxm;ol\xkd;jrJvufrSwf

UNDERTAKING

(a) I/We hereby declare that the amount of foreign exchange approved on the reverse of this application will be utilized by me/us only for the purpose for which approval is granted.

(b) I/We hereby also undertake to bring back the unexpended foreign exchange if any and to declare them truly on my/our arrival back in Myanmar and surrender them to the Central Bank of Myanmar, immediately, in accordance with the provisions of the Foreign Exchange Requlation Act, and rules directions or orders made thereunder.

Date._______________ _____________________ Signature of Applicant

--------------------------------------------------------------------------------------------------------------------------------------------

To be filled by the KBZ BANK

Amount Remittance Kyats Pyas Day Month Year

To be filled by the KBZ BANK (Exchange Control)

Serial No. Types of Form

Payment B/L Date Country and Currency

Purpose Agency Commodity

Month Year

Coded by__________________ Checked by_______________