1. This form need not be completed in cases where the aggregate value of the foreign exchange brought in by the passenger in the form of currency notes, bank notes, or travellers cheques does not exceed U.S.$ 10,000/- or its equivalent and/or the value of foreign currency notes does not exceed U.S.$ 5,000 or its equivalent.

2. Passengers are advised to produce this form to a bank authorised to deal in foreign exchange or money changer at the time of conversion of foreign exchange into Indian rupees or reconversion of rupees into foreign exchange.

3. Visitors to India may please note that in case they do not wish to encash all the foreign exchange declared above they should retain this form with them for production to the Customs at the time of their departure from India to enable them to take with them the unutilised balance.

4. Details of travellers’ cheques/currency notes need not be furnished.

5. Foreign tourists need not indicate their address.

______________________________________________________________________________

(To be completed by passenger)

I_____________________________________________________________________________

hereby, declare that the following foreign exchange is in my possession at the time of my arrival in India:

(Aggregate value only)

Signature____________________________

Passport No._________________________

Nationality__________________________

Address in India______________________

_____________________________________________________________________________

This is to certify that the above named person has brought with him foreign exchange as

indicated above.

Date____________ _________________________________

(Stamp and Signature of Customs Officer)

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(Space for endorsement)