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Youre nearly there! To ensure that your payment is received by your institution without any delays,please follow the instructions below:

Due to Indian regulations, in order to complete your payment you will need to present the attached OutwardRemittance Request Form along with proof of identity and address at a local ICICI Bank branch.

To find the nearest ICICI Bank branch, please use their branch locator by clicking Here.

1.rint the !utward "emittance "e#uest and ayment Instructions forms

$.%ill out the !utward "emittance "e#uest form. &ote that much of the information has been pre'populated foryour con(enience. Below are the items which are to be completed by the person making the I&" payment)remitter*. t is important that all items below are completed in full to ensure efficient processin of yourpayment.

"ection #: The remitter fills in their &ame, +ddress and hone &umber.

"ection $%b: %ill in the designated amount of I&" shown on the attached instructions in words. nsurethat the amount populated in numbers as well.

"ection &:'' (''O)*T +O-.R" O*Y / The remitter pro(ides the ICICI I&" account number tobe debited for the payment. )&on'ICICI account holders see Item - below*

"ection0:ro(ide the tudent &ame, tudent ID and Country of tudy +broad.

"ection1:lease ensure that the ICICI representati(e includes the displayed Reference*umber withthe wire payment.

"inature:The remitter signs and dates the !utward "emittance "e#uest at the end of the Declarationon age /.

/.Take the printed0signed documents and present your proof of identify and address for (erification by ICICIBank. The ICICI representati(e will complete the 23C Certification with the remitter as applicable. +cceptableidentification includes4

Proof of Identity Proof of Address

PAN Card Passport

Voter ID Card Telephone Bill

Driving License Electricity Bill

Government ID Card Bank tatement !ith che"#e

Photo ration card Certi$icate%ID Card% avings Pass Book iss#ed &y Post

'$$ice

enior citi(en ID card Latest premi#m receipt o$ any li$e ins#rance co

Passport Cons#mer gas connection card%&ook%Pipe gas &ill

Leave%Lease and License Agreement

-.&on'ICICI account holders will transfer funds locally from their respecti(e bank accounts to ICICI Bank poolaccount through &%T0"T5 as per the details mentioned below4

Beneficiary &ame4 !utward "emittance ool +ccount

+ccount &umber4 66/78!"CBC I%C Code4 ICIC66666/7

7.ICICI Bank will process your re#uest. 9estern :nion Business olutions will then deli(er the C+D payment toyour school to complete the payment.

The followin quote is valid until4

You cannot use this sheet after this date. If the date above has passed, go online again and create a new quote. Note that there will be a

small processing fee charged by ICICI Bank.

14 April 2014 04:46 GMT.

http://www.icicibank.com/Personal-Banking/account-deposit/Outward-Remittance/pdf/active_branch_list.pdfhttp://www.icicibank.com/Personal-Banking/account-deposit/Outward-Remittance/pdf/active_branch_list.pdf

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A2 CUM RETAIL OUTWARD REMITTANCE APPLICATIONFor Official Use only

Track Number Originating Br. ID Scan Br. ID AD C!e

"T be cm#$ete! b% t&e a##$icant in b$ck $etter' u'ing b$ack ink #en(

A##$icatin )r !ra*a$ ) +reign E,c&ange

I. Detai$' ) t&e A##$icant "Remitter(

a. Name of the Applicant

b. Address (Not mandatoryfor ICICI A/c holders)

Applicant Phone numbers

II. Detai$' ) +reign E,c&ange re-uire! "+i$$u# eit&er II a r II b( "Re) Anne,II in #age / )r

a##$icab$e Currenc% Detai$'(

II a. +r remittance ) )i,e! amunt ) +reign Currenc%

Forein CurrencyFCAmount In

!ordsFC Amt in fiures

"OR( II b. +r remittance ) e-ui0a$ent ) +reign Currenc% ) +i,e! Ru#ee Amunt

Forein Currency CA"IN#Amount In!ordsIN# Amt in fiures

II c. Pur#'e ) Remittance *it& Pur#'e C!e "+r !etai$' re)er Anne,ure 1 I in #age (Code

$%%&'"escription

ducation

III. I 3 We aut&ri4e %u t !ebit m% 3 ur be$* Accunt tget&er *it& %ur c&arge'

5 C&arge'

brne b%

bene)iciar%

"BEN(

5 C&arge'

brne b%

remitter

"REM(6

Chares *ill be to the Account of +eneficiary (+N) if no option is selected

III a. P$ea'e i''ue

,eleraphic ,ransfer(,,) - "r( "emand "raft ("")

Bene)iciar% Name

, # A - 0 O + A

+ U $ I N $ $ P A 1 2 N , $

Bene)iciar% A!!re''

% % 3 4 % 3 , 5 $ , # , N ! ' , 5 F O O #

! A $ 5 I N 0 , O N " C 4 & & & 3

I7 a. Bene)iciar% A3c Number "Inca'e ) TT(

& & & & % % 6 7 % 6 8 %

INR 5,739.08

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A2 CUM RETAIL OUTWARD REMITTANCE APPLICATION

I7 b. Name ) t&e Bank *&ere t&e bene)iciar% A3c i' maintaine! "In ca'e ) TT(

# O 1 A + A N 9 O F C A N A " A

I7 c. SWI+T 8 SORT C!e !etai$' ) bene)iciar% Bank "In ca'e ) TT(

I+AN for remittance made toU9: urope: +ahrain $audiArabia ; UA

$ort Code for remittance toU9 (or) +$+ Code forremittance to Australia

$!IF, code (or) routin Number forremittance to any other Country

#O1CCA,4

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A2 CUM RETAIL OUTWARD REMITTANCE APPLICATION

I7 !. Bene)iciar% Bank a!!re'' inc$u!ing Cuntr% at *&ic& t&e bene)iciar% maintain' A3c " man!atr%

in ca'e ) TT in CAD Currenc%(

% < & ! I N 0 , O N $ , # ,

, O # O N , O O N , A # I O 2 3 % % = %

I7 e. +urni'& t&e )$$*ing !etai$' ) Crre'#n!ent Bank i) t&e +reign Currenc% i' 'ent t a

Cuntr% t&er t&an t&e &me Cuntr% ) t&e Currenc%

SWI+T C!e Crre'#n!ent Bank Name

7. I) t&e #ur#'e 'e$ecte! i' ne ) t&e be$* t&en it i' man!atr% t )urni'& t&e !etai$' 'ug&t )r

Maintenance,he relationship of beneficiary *ith the remitter (for list of close relati>es refer the table i>enbelo*)

E!ucatin ,he $tudent Name and $tudent I" (if any). Country of study abroad

Purc&a'e )Pr#ert%

,he location of property bein purchased (Country / $tate)

In0e'tment abra!Nature of instrument (?uity / 2F / "ebt Instrument) and country of incorporation of thecompany in *hich the in>estment is made

"etails

Li't ) c$'e re$ati0e' a' #er Sec 7I ) Cm#anie' Act

+rother (includin step +rother) "auhter@s $on@s !ife 2other (includin $tep 2other) $on@s "auhter

+rother@s *ife "auhter@s 5usband 2other@s Father $on@s "auhter@s 5usband

"auhter (Includin $tep "auhter) Father 2other@s 2other $on@s $on

"auhter@s "auhter Father@s Father $ister (Includin $tep $ister) $on@s $on@s *ife

"auhter@s "auhter@s 5usband Father@s 2other $ister@s 5usband $on@s *ife

"auhter@s $on 2ember of 5UF $on (Includin step $on) 5usband (or) !ife

7I. +urni'& be$* i) a me''age t be 'ent a$ng *it& *ire tran')er n %ur be&a$)

INR

Dec$aratin

I / !e hereby declare that the total amount of forein echane purchased from or remitted throuh all sources in India durin thisCalendar / Financial year includin this application is *ithin U$" imit as prescribed by #+I for the said purpose under F2A %777

CA53210KOOU1940

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A2 CUM RETAIL OUTWARD REMITTANCE APPLICATION

I/ !e hereby declare that the transaction mentioned abo>e doesn@t in>ol>e: and is not desined for any purpose for *hich the dra*in offorein echane is prohibited under rule B of the F2A Current A/c transactions #ules: 4&&& read *ith schedule I therefore of i:

%. ,ra>el to Nepal ; or +hutan4. ,ransaction *ith a person resident in Nepal or +hutanB. #emittance out of lottery *innins8. #emittance of Income from #acin / ridin etc. or any other hobby.3. #emittance for purchases of ottery ticDets: banned or prescribed maaines: football pools: s*eep staDes: schemes in>ol>in money

circulations: securin prie money a*ards etc.6. Payment of commission on eports made to*ards e?uity in>estments in Eoint >entures / *holly o*ned subsidiaries abroad of Indian

Companies'. #emittance of di>idend by any company to *hich the re?uirement of di>idend balancin is applicable.oice >alue of eports of ,ea ;

,obacco.7. Payment related to GCall bacD ser>icesH or telephones.%&. #emittance of interest income on funds held in nonresident special rupee a/c schemes.

I / !e: bein a person(s) resident in India: hereby declare that for transactions done under the iberalied #emittance $cheme (#$) forresident indi>iduals: issued and amended by #+I from time to time: is not in the nature of remittance for marin calls to o>erseas echanes/ o>erseas counter parties under this scheme.

I / !e: bein a person(s) resident outside India: here by declare that under $ec 8(b) of F2A Permissible Capital A/c ,ransactionreulation: 4&&&: the transaction mentioned abo>e doesn@t in>ol>e and is not desined for any repatriation outside India out of the proceedsof any in>estment in India: in any form: in any Company: Partnership firm (or) Proprietary concern or any entity: *hether incorporated or not:

*hich is enaed or proposes to enae

a. In the business of chit funds or

b. As Nidhi company or

c.In aricultural or plantation acti>ity: ord. In real estate business: or construction of farm houses (real estate business shall not include de>elopment of to*nships construction of

residential / commercial premises roads or brides): or

e.In tradin and transferable de>elopment rihts (,"#s)

I / !e bein a person(s) resident outside India: here by declare that no portion / part of out*ard remittance represents interest on refunds offunds recei>ed from outside India for purchase of shares in India. Updated list of prohibited transactions under F2A can be accessed on

ICICI +anD *ebsite (***.icicibanD.com).

Ot&er re$e0ant !ec$aratin'9

I/*e hereby declare that the purpose and transaction details as mentioned abo>e are true to the best of my Dno*lede does not in>ol>e:and is not desined for the purpose of any contra>ention or e>asion of the pro>isions of the F2A: %777 or any rule: reulation: notification:direction or order made there under. I/!e aree that I/!e shall be responsible and liable for any incorrect detail pro>ided by me/us.

I/!e also hereby aree and undertaDe to i>e such information / documents as *ill reasonably satisfy you about this transaction in terms ofthe abo>e declaration.

I/*e aree that in the e>ent of transaction could not be eecuted/debited to my/ our account after submittin the re?uest for processin tothe banD on account of insufficient/ unclear balance at the same time of eecution of the transaction in my/ our account any echanelosses incurred in this connection due to re>ersal of the Fore deal can be chared to my/our ICICI account.

I/*e aree that in the e>ent the transaction is cancelled or re>oDed by me/us after submittin the re?uest for processin to the banD anyechane losses incurred in this connection can be chared to my/our ICICI account. I/*e further aree that once the funds remitted byme/us ha>e been transmitted by ICICI banD to the correspondent and/or beneficiary banDs: ICICI banD shall not be responsible for anydelays I the disbursement of such funds includin the *ithholdin of such funds by the correspondent and/or beneficiary banDs. I/!e furtheraree that once the funds remitted by me / us ha>e been transmitted by ICICI +anD: intermediary +anD chares may be le>ied byCorrespondent and / or +eneficiary +anDs: *hich may >ary from banD to banD.

I/*e aree that in the e>ent the transaction bein reEected by the beneficiary banD because of incorrect information submitted by me: anychares le>ied by the beneficiary banD or echane losses incurred in this connection can be chared to my ICICI banD account.

I/*e also understand that if I/*e refuse to comply *ith any such re?uirement or maDe only unsatisfactory compliance there*ith: the banD

shall refuse in *ritin to undertaDe the transaction and shall: if it has reason to belie>e that any contra>ention/e>asion in contemplated byme/us: report that matter to the #+I.

I/*e also aree that the echane rate *ill be applicable at the time of deal booDin and may >ary from the rate pre>ailin *hen the re?uestis submitted . I/*e also understand that the rate communicated to us (if any) is an indicati>e rate and the actual rate may be different fromthe same.

I / !e authorie you to remit out*ardly as per details pro>ided in the application.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

"ate JJJJJJJJ. Signature ) Remitter 3 Man!ate

:$!er(,he sinature by mandate holder *ill be accepted only for Non resident A/c holders *here mandate is duly reistered *ith the +anD )

I certify that I ha>e >erified the Customer@s sinature as per +anD records and retained the oriinals of all the scanned

documents and forms submitted by the remitter for the abo>e transaction.

Name ; employee I" +anD $tamp ; mployee $inature

http://www.icicibank.com/http://www.icicibank.com/

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A2 CUM RETAIL OUTWARD REMITTANCE APPLICATION

(For Office Use Only)

Anne,ureIII

91C Certification"T be )i$$e! an! 'canne! n$% in ca'e ) remittance b% nn ICICI Cu'tmer(

I met 2r./2s./2rs. KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK at his / her residence / office / other location (specify)

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK and hereby confirm the identity and address i>en belo*

;. Remitter Name

2. Remitter A!!re''

I confirm ha>in >erified the copies of documents (as applicable) *ith the oriinals produced by the applicant.

Also I confirm that the applicant has sined the documents in my presence. ist of 91C documents pro>ided.

I" Proof

Address Proof

Name of the +anD official KKKKKKKKKKKKKKKKKKKKKKKKKKK mployee No. KKKKKKKKKKKK "esination

KKKKKKKKKK

"ate L KKKKKKKKKKKKKKK $inature of the +ranch Official and +ranch stamp

Name of +2 / +O2 authoriin 91C certification abo>e KKKKKKKKKKKKKKKKKKKKKK mployee No.

KKKKKKKKKK

"ate L KKKKKKKKKKKKKK $inature of the +ranch Official and +ranch stamp

"etails of IN# amount credited to the pool a/c (Incl. of Chares M $er>ice ,a) KKKKKKKKKKKKKKKKKKKKKKK

Finacle ,ran I". KKKKKKKKKKKKKKKKK I+# No. KKKKKKKKKKKKKKKKKKKKK "ate of credit

KKKKKKKKKKKKKKKKKKKKKK into Pool A/c No.&&B3$O#C+PC (incase of any other a/c specify)

KKKKKKKKKKKKKKKKKKKKKKKKKKK

(If the remittance is by *ay of acceptin cash deposit then the amount should not eceed IN# 3&:&&&/)