Department Code

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Bank or Travel Agency

Date

Serial number of

Exchange Control Amount

Application Forms Issued

Seal of Bank or .

Travel Agent issuin,

Foreign Exchange}

i

SAMI AKHTAR DEWAN

Frezaw aifts/ Next of Kin

arm/ Relationship

FATHER

BISHRAMPUR, 09 BAHUDARMAT, PARSA.

Sar Address

a

z

s

=

é

2

o

8

3

&

3

F

=

E

§

E

E

E

B:

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