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["Bank of India, Tokyo Branch"]
[]
["Form #401   USD → INR",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date:"]
[]
["Application for INR Remittance （USD→INR）"]
[]
["Please debit my USD A/C  and remit INR at prevailing exchange rate as under."]
[" Debit A/C No.",null,null,null,null,null,null,"4241 231 02"]
["Amount",null,null,"Currency"]
[null,null,null,"USD"]
["In words"]
[]
["Beneficiary Bank"]
["Branch Name"]
["IFSC Code"]
["Beneficiary Name"]
["Address"]
["A/C No."]
["Purpose:",null,null,null,null,null,null,null,null,"Savings/Transfer to Own Account"]
[null,null,null,null,null,null,null,null,null,"Family Support \n(Relationship with Beneficiary:"]
[null,null,null,null,null,null,null,null,null,"Others (Specify:"]
[null,null,"I have read Doc.#139 Economic Sanctions under the Foreign Exchange Act which is available in the Bank's \nwebpage and declare that the above remittance is not applicable to the remittance restricted under the \nForeign Exchange Act and other relevant acts and sanctions pertaining to oveseas remittances. "]
[]
["For the Bank's Use",null,null,null,null,null,null," Exchange Rate"]
["Amount",null,null,"Currency",null,null,null,{"$f":"ROUND(H9*P24,0)","v":0}]
[null,null,null,"INR"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Applicant's Name:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Designation:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C/o  Embassy of India, Tokyo"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CIF No."]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Applicant's Signature"]
[]
["For the Bank's Use"]
[]
[null,"Commission:",null,null,null,null,null,null,null,null,null,"SVS Verified:",null,null,null,null,null,null,null,null,null,"Economic Sanctions Verified:"]
[]
[]
[]
[null,"SJP",null,null,null,null,null,null,"S",null,null,null,null,null,null,null,"Entered by:",null,null,null,null,null,null,"Authorized by:"]
[]
[]
[]
[null,"Contact:",null,null,"Phone: ",null,null,"03-3212-0911",null,null,null,"Fax:    ",null,"03-3214-8667",null,null,null,null,"E-mail:",null,"Remittance.Tokyo@bankofindia.co.in"]
[null,"Address:",null,null,"1st Floor Marunouchi-Nakadori Bldg., 2-2-3 Marunouchi, Chiyoda-ku, Tokyo 100-0005"]

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["Bank of India, Tokyo Branch"]
[]
["Form #401   USD → INR",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date:",null,"2019-07-01"]
[]
["Application for INR Remittance （USD→INR）"]
[]
["Please debit my USD A/C  and remit INR at prevailing exchange rate as under."]
[" Debit A/C No.",null,null,null,null,null,null,"4241 231 02",null,null,null,null,null,null,null,null,null,null,null,"000085"]
["Amount",null,null,"Currency",null,null,null,2500]
[null,null,null,"USD"]
["In words",null,null,"US dollars two thousand five hundres only"]
[]
["Beneficiary Bank",null,null,null,null,null,null,null,"BOIB BANK"]
["Branch Name",null,null,null,null,null,null,null,"Parliament Street Branch"]
["IFSC Code",null,null,null,null,null,null,null,"BOIB 0000123"]
["Beneficiary Name",null,null,null,null,null,null,null,"Amit Gandhi"]
["Address",null,null,null,null,null,null,null,"123 Parliament Street, New Delhi, India"]
["A/C No.",null,null,null,null,null,null,null,"016801075399"]
["Purpose:",null,null,null,null,null,null,null,null,"Savings/Transfer to Own Account"]
[null,null,null,null,null,null,null,null,null,"Family Support \n(Relationship with Beneficiary:",null,null,null,null,null,null,null,null,null,"Brother"]
[null,null,null,null,null,null,null,null,null,"Others (Specify:"]
[null,null,"I declare that the above remittance is not related directly or indirectly to  the remittance restricted under the Foreign Exchange and Foreign Trade Act in respect of Iran and North Korea, and other restricted transactions. 　　　"]
[]
["For the Bank's Use",null,null,null,null,null,null," Exchange Rate"]
["Amount",null,null,"Currency",null,null,null,{"$f":"ROUND(H9*P24,0)","v":0}]
[null,null,null,"INR"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Applicant's Name:","Rajeev Gandhi"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Designation:","First Secretary"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C/o  Embassy of India, Tokyo"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CIF No.",null,null,110000543]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Applicant's Signature"]
[]
["For the Bank's Use"]
[]
[null,"Commission:",null,null,null,null,null,null,null,null,null,"SVS Verified:",null,null,null,null,null,null,null,null,null,"Economic Sanctions Verified:"]
[]
[]
[]
[null,"SJP",null,null,null,null,null,null,"S",null,null,null,null,null,null,null,"Entered by:",null,null,null,null,null,null,"Authorized by:"]
[]
[]
[]
[null,"Contact:",null,null,"Phone: ",null,null,"03-3212-0911",null,null,null,null,null,"Fax:    ",null,"03-3214-8667",null,null,null,null,null,"E-mail:",null,null,"boitok@gol.com"]
[null,"Address:",null,null,"1st Floor Marunouchi-Nakadori Bldg., 2-2-3 Marunouchi, Chiyoda-ku, Tokyo 100-0005"]