Fema Forms CA. Anshuman Chaturvedi 23June 12

(Use code as per Box1)Multi Currency TypeName and address of the Borrower (BlockLetters)Contact Person's Name:Designation:Phone No. :Fax no. :E-mail ID :(For RBI DESACS use)Name and address of lender / foreign supplier /lesser (Block Letters)Country:E-mail ID :(For RBI DESACS use)Borrowers Category (Tick in appropriate box)Public Sector Unit Private SectorUnitDetailed category (tick below)BankNBFC Reg.No.Financial Institution (Other than NBFC)CorporateNGOs engaged in micro finance activityOther (Specify)Details of foreign equity holding of the lender inborrower company:(a)Share in paid-up equity of the borrower (%)Specify Authorised Dealers Name, and bank codeBank Code Part I:Fax :E-mail ID:Part II:Part B: Other DetailsECB approval Scheme (Tick in appropriate Box)Automatic RouteApproval RouteApproved by Govt.Lender's CategoryMulti-lateral Financial InstitutionForeign Government (Bilateral Agency)Export Credit AgencyIndian Commercial Bank branch abroadOther Commercial BankSupplier of EquipmentLeasing CompanyForeign Collaborator / Foreign Equity Holder(Please provide details of foreign equityholding in the borrower company below)International Capital MarketOther (Specify)(b) Amount of paid-upequityLender's Reference / IBRD No. (if it is a IBRD loan)Maturity DetailsEffective Date of the LoanLast Date of DisbursementMaturity Date (Last paymentdate)Grace Period (Year/Month) Y Y M M39