Form A1 (for Import Payment Only) (application For Remittance In

FORM A1 (For Import Payment Only) (Application for Remittance in Foreign Currency) Amount Remitted

_US Dollars______$4295.00____________________ Currency Amount

Equivalent to Rupees ____________________ (To be completed by Authorised Dealer)

Serial No. ___________________________ (for use of Reserve Bank of India) A.D. Code No. 06910204-6000009 Form No. ___________________________ (To be filled by Authorised Dealer)_______

I/ We wish to purchase ____US Dollars________Four Thousand two hundred and ninety five only____ (Name of currency) (Amount in words) through _______________________________________________________________________________________________________ or payment to (Name and address of the Authorised Dealer) Avnet Asia Pte. Ltd, 151 LORONG CHUAN ,NEW TECH PARK,#06-03, Singapore 556741 payment of (Name and address of the Beneficiary of the remittance) imports into India, detailed below:

O.G.L. __________________ NUMBER PART IMPORT LICENCE PREFIXES LICENCE NO. 1 2 1

Details of goods imported or to be imported into India Section A: Import Licence/Open General Licence Particulars __________________ __________________ SCHEDULE SERIAL NUMBER DATE OF ISSUE DATE OF EXPIRY FACE AMOUNT T0 BALANCE OUTSUFFIXES Date Month Year Date Month Year VALUE OF BE LICENCE ENDORSED STANDING ON (IN Rs. ) @ THE 2 3 4 5 LICENCE AFTER THE REMITTANCE

@ Actual Amount endorsed in Rupees against each licence involved should be stated under this column. NOTE: If more than one licence is involved, particulars of all licences should be furnished in inadequate, a separate statement may be attached. The amount utilised against each licence should invariably be indicated. Section B: Import particulars Invoice Details Qty of Description of goods BTN Country of Country from Mode of Date of Classifica- origin of goods which goods Shipment Shipment (if Invoice Terms Currency Amount goods Tions are consigned (air, sea, not known No. and (c.i.f.) post, rail, approximate Date F.O.B. river, date) c.& f. transport etc. etc.

EF-ISE-SYSTEM-NL

1

(PRODUCT: SOFTWARE) MANUFACTURER :XILINX INC.

UNITED STATES

INTERN ET WEB BASED DELIVE RY OF SOFTW ARE (NO PHYSIC AL SHIPM ENT)

Section C: Other particulars 1. Details of forward purchase contract if any, booked against the import.

_____________________ (No. & Date of Contract) of contract) 2. If remittance to be made is less than invoice value reason therefore (i.e. part remittance, instalment etc.)

_________________ ______________ (Currency and Amount (Balance under the contract) ____________________________________ ____________________________________

I/We hereby declare that the statement made by me/us on this form are true and that I/We have not applied for an authorisation through any other bank. I/We declare and also understand that the foreign exchange to be acquired by me/us persuant to this application shall be used by me/us only for the purpose for which it is acquired and that the conditions subject to which the exchange is granted will be complied with. Name of Applicant(s)

:

Address of Applicant(s) : Import Code No.

Nationality of Applicant(s) For .

:

Date: ___________ Note: for remittances covering intermediary trade. Form A2 should be used.

AUTHORISED SIGNATORY.

DECLARATION – CUM- UNDERTAKING (UNDER SEC. 10(5), CHAPT III OF THE FOREIGN EXCHANGE MANAGEMENT ACT, 1999) I/We hereby declare that the transaction(s), the details of which are specifically mentioned in the schedule hereunder does not involve and is not designed for the purpose of any contravention or evasion of the provisions of the aforesaid Act or of any rule, regulation, notification, direction or order made thereunder. I/We also hereby agree and undertake to give such information/documents, before the Bank undertakes the transaction(s) and as may be required from time to time as will reasonably satisfy you about the transaction(s) in terms of the terms of the above declaration. I/We also understand that if I/We refuse to comply with any such requirement or make unsatisfactory compliance therewith, the Bank shall refuse in writing to undertake the transaction and shall if it has reason to believe that any contravention/evasion is contemplated by me/us report the manner to Reserve Bank. I / We further declare that the undersigned has/have the authority to give this declaration and undertaking on behalf of the firm / company. Place : Mumbai Date : __________ •Applicable when the declaration / undertaking is signed on behalf of the firm / company. Declaration to be furnished by Applicant(s) I/We declare that

(a)the goods to which this applicant relates have been* imported into India on my/our account* will be (b)the import is on behalf @ _______________________________________________________________________ and

(c)the invoice value of the goods which is declared on this form is the value of the goods imported*

into India.

to be imported * If the import has been made If the import is to be made

I/We such the relative Custom-stamped Exchange Control Copy of Bill of Entry* Post Parcel Wrapper (for Import by post*) or I/We undertake to produce within three months to the authorised dealer the relative Control copy of Bill of Entry* (for imports by post)* *Stike out item not applicable

Custom-stamped Exchange Post Parcel Wrapper

@ Where the import is on behalf of Central/State Government Department or a Company owned by Central/State Government, Statutory Corporation Local Body, etc. the name of Government Department Corporation etc. should be stated. For Date: ___________

AUTHORISED SIGNATORY. Signature of Applicant(s)

Space for comments of the Authorisd Dealer while forwarding the application to the Reserve Bank of India for approval Reference to Exchange Control Manual paragraph, A.D. circular, in terms of which the reference is made should invariably be cited. If any remittance application on account of the same import was required to the Reserve Bank earlier, reference to the last cocrrespondence/approval should also be cited. Date: ______________

(Stamp and Signature of Authorised Dealer)

Certificate to be furnished by Authorized Dealer (Importers Banker) We hereby certify that, (a) this payment is Put a

(i)

an advance remittance.

(ii)

in retirement of bills under Letter of Credit opened through us.

(iii)

against documents received through our medium for collection.

(iv)

on account documents received by the applicant(s) against undertaking furnished by the letter to submit Customs-stamped Exchange Control Copy of Bill of Entry/Post Parcel Wrapper within three months

(v)on account of documents received direct by the applicant(s) against Custom-Stamped Exchange Control Copy of Bill of Entry/Post Parcel Wrapper (attached submitted by the letter) (vi) (any other case to be explained) (b) all the Exchange Control Regulations applicable to the remittance have been complied with (c)the payment to the suppliers of the goods has been* made through ______________________________________ will be (Name and address of the foreign Bank) We also certify/undertake that the relevant Customs-stamped Exchange Control Copy of Bill of Entry or Post Parcel Wrapper * shall be verified by us within three months (vide certificate (a) (ii) and (iii) above) * has been verified (vide certificate (a) (v) above) shall be obtained from the applicant(s) and forwarded to the Reserve Bank within three months (vide certificate (a) (i) and (iv) above) *strike out item not applicable Stamp and Signature of Authorised Dealer)