APPLICATION FOR REQUEST OF FOREIGN INWARD REMITTANCE CERTIFICATE (FIRC)

To

The Branch Manager,

HDFC Bank Ltd,

Kochi Branch.

Dear Sir,

I hereby request you to issue Foreign Inward Remittance Certificate (FIRC) for the foreign currency
amount received by me through Kochi branch of HDFC Bank. The details of the said remittance are as
follows:

Your Ref.No. :_________________________________

Amount of Remittance :_________________________________

Date of Remittance :_________________________________

Name & Address of the Remitter : Google Inc, USA

Purpose of Remittance : Advertising income from Google AdSense program through the blog <blog
name>

Date : ______________________

Place: ______________________ (Applicant’s Name & Signature)