Bidvest Bank Limited (Reg No 2000/006478/06) is a licensed financial services and registered credit provider, NCRCP17.
Balance of Payment FormBank purchase from customer
Page 1/4
APPLICATION TO SELL FOREIGN CURRENCYBALANCE OF PAYMENTS (BOP) REPORTING
Date
Name of entity
or Name and surname of individual
or Name and surname of individual
Registration number of entity
Country code
VAT/Tax no. of applicant
RSA resident
RSA resident
Identification number of individual
Customer number
Full residential or
Country
Applicant telephone
Transaction type
Name of entity
Unique Consignment Reference (UCR)
Authorised signatory or initial
Address
Country
Details of transfer
Value date
Exchange rate
Settlement currency
Account to be credited
*Settlement currency in ZAR or the denomination currency of the CFC account being credited if the CFC account has been selected
T.T Fee
Payment currency Payment amount
Settlement amount
.
.
. .
Telegraphic transfer
Current account or CFC account
Contact name of entity
Wish to sell foreign currency
Remitter Details
Beneficiary Details (Receiver)
Reserve Bank Reporting
Fax/email
Business address(Not PO Box number)
Branch name Branch number
(INWARD PAYMENT FLOWS)
Y / N
Y / N
D D M M Y Y Y Y
A Z A N N N N N N N N I N V N N N N N N N N N N N N
Bidvest Bank Limited (Reg No 2000/006478/06) is a licensed financial services and registered credit provider, NCRCP17.
Balance of Payment FormBank purchase from customer
Page 2/4
Insert “X” in applicable box
A. MERCHANDISE
B. INTELLECTUAL PROPERTY AND OTHER SERVICES
100
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107 232
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104
106
Adjustments / Reversals / Refunds applicable to merchandise
Adjustments / Reversals / Refunds applicable to intellectual property and service related items
Fees for processing - processing done on materials (excluding gold, platinum, crude oil, refined petroleum products, diamonds, steel, coal and iron ore)
Travel services for non-residents - business travel
Travel services for residents - business travel
Proceeds for travel services in respect of third parties - business travel
Proceeds for telecommunication services
Proceeds for passenger services - road
Proceeds for freight services - road
Proceeds for other transport services - road
Proceeds for postal and courier services - road
Proceeds for passenger services - sea
Proceeds for freight services - sea
Proceeds for other transport services - sea
Proceeds for postal and courier services - sea
Proceeds for passenger services - rail
Proceeds for freight services - rail
Proceeds for other transport services - rail
Proceeds for postal and courier services - rail
Proceeds for passenger services - air
Proceeds for freight services - air
Proceeds for other transport services - air
Proceeds for postal and courier services - air
Travel services for non-residents - holiday travel
Travel services for residents - holiday travel
Proceeds for travel services in respect of third parties - holiday travel
Proceeds for information services including data, news-related and news agency fees
Foreign exchange accepted by residents from non-residents
Fees for processing - processing done on gold
Fees for processing - processing done on platinum
Fees for processing - processing done on crude oil
Fees for processing - processing done on refined petroleum products
Fees for processing - processing done on diamonds
Fees for processing - processing done on steel
Fees for processing - processing done on coal
Fees for processing - processing done on iron ore
Repairs and maintenance on machinery and equipment
Architectural, engineering and other technical services
Agricultural, mining, waste treatment and depollution services
Disposal of patents and inventions
Proceeds received for research and development services
Sales of original manuscripts, sound recordings and films
The outright selling of ownership rights of software
Disposal of patterns and designs (including industrial processes)
Funding received for research and development
Receipt of funds relating to the production of motion pictures, radio and television programmes and musical recordings
Computer-related services including maintenance, repair and consultancy
Disposal of copyrights
Disposal of franchises and trademarks
Rights assigned for licences to reproduce and/or distribute
Rights assigned for using patents and inventions (licensing)
Rights assigned for using patterns and designs (including industrial processes)
Rights assigned for using copyrights
Rights assigned for using franchises and trademarks
Export advance payment (excluding capital goods, gold, platinum, crude oil, refined petroleum products, diamonds, steel, coal, iron ore and goods exported via the South African Post Office)
Export payment (excluding capital goods, gold, platinum, crude oil, refined petroleum products, diamonds, steel, coal, iron ore and goods exported via the South African Post Office)
Consumables acquired in port
Export proceeds where the Customs value of the shipment is less than R500
Commercial sales of customised software and related licences for use by customersCommercial sales of non-customised software on physical media with periodic licence to useCommercial sales of non-customised software provided on physical media with right to perpetual (on-going) useCommercial sales of non-customised software provided for downloading or electronically made available with periodic licenceCommercial sales of non-customised software provided for downloading or electronically made available with single payment
Export payments where goods were declared as part of passenger baggage and no UCR is availableProceeds for goods purchased by non-residents where no physical export will take place (excluding gold, platinum, crude oil, refined petroleum products, diamonds, steel, coal and iron ore as well as merchanting transactions)Proceeds for gold purchased by non-residents where no physical export will take place, excluding merchanting transactionsProceeds for platinum purchased by non-residents where no physical export will take place, excluding merchanting transactions
Proceeds for refined petroleum products purchased by non-residents where no physical export will take place, excluding merchanting transactions
Proceeds for steel purchased by non-residents where no physical export will take place, excluding merchanting transactions
Proceeds for crude oil purchased by non-residents where no physical export will take place, exclud-ing merchanting transactions
Proceeds for diamonds purchased by non-residents where no physical export will take place, excluding merchanting transactions
Proceeds for coal purchased by non-residents where no physical export will take place, excluding merchanting transactionsProceeds for iron ore purchased by non-residents where no physical export will take place, excluding merchanting transactionsNot allocated
Merchanting transaction
Not allocated
Not allocated
Export advance payment - capital goods
Export payment - capital goods
Export advance payment - gold
Export payment - gold
Export advance payment - platinum
Export payment - platinum
Export advance payment - crude oil
Export payment - crude oil
Export advance payment - refined petroleum products
Export payment - refined petroleum products
Export advance payment - diamonds
Export payment - diamonds
Export advance payment - steel
Export payment - steel
Export advance payment - coal
Export payment - coal
Export advance payment - iron ore
Export payment - iron ore
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Trade finance repayments in respect of exports
Export advance payment - goods exported via the South African Post Office
Export payment - goods exported via the South African Post Office
1
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TRANSACTION ADJUSTMENTS
TRANSACTION ADJUSTMENTS
TECHNICAL RELATED SERVICES
TRAVEL SERVICES FOR NON-RESIDENTS
TRAVEL SERVICES FOR RESIDENTS
TRAVEL SERVICES IN RESPECT OF THIRD PARTIES
TELECOMMUNICATION AND INFORMATION SERVICES
TRANSPORTATION SERVICES
DISPOSAL OF INTELLECTUAL PROPERTY (EXCLUDING COMPUTER-RELATED AND AUDIO-VISUAL)
RESEARCH AND DEVELOPMENT
AUDIO-VISUAL AND RELATED ITEMS
COMPUTER SOFTWARE AND RELATED ITEMS
CHARGES FOR THE USE OF INTELLECTUAL PROPERTY
EXPORTS: ADVANCE PAYMENTS
EXPORTS: PAYMENTS
EXPORTS: OTHER
Bidvest Bank Limited (Reg No 2000/006478/06) is a licensed financial services and registered credit provider, NCRCP17.
Balance of Payment FormBank purchase from customer
Page 3/4
Insert “X” in applicable box
275
280
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285
287
400
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511
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510
512
530
512
530
512
530
512
530
531
512
530
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530
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530
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530
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510
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312
313
314
315
291
289
293
296
298
288
292
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297
299
282
276
Commission and fees
Proceeds for construction services
Proceeds for government services
Tuition fees
Proceeds for legal services
Adjustments / Reversals / Refunds related to transfers of a current nature
Adjustments / Reversals / Refunds related to financial investments/disinvestments and prudential investments
Investment in listed shares by a non-resident
Investment in non-listed shares by a non-resident
Disinvestment by a resident individual - shares
Disinvestment by a resident individual - mutual funds / collective investment schemes
Disinvestment by a resident individual - money market instruments
Disinvestment by a resident individual - other
Disinvestment by a resident individual - bonds
Disinvestment by a resident individual - property
Disinvestment by a resident individual - deposits with a foreign bank
Not allocated
Adjustments / Reversals / Refunds related to capital transfers and immigrants
Donations to SA Government for fixed assets
Investment into property by a non-resident individual
Not allocated
Immigration
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Not allocated
Repatriation, on instruction by the Financial Surveillance Department, of a foreign investment by a resident individual in respect of cross-border flows
Repatriation, on instruction by the Financial Surveillance Department, of a foreign investment by a resident individual originating from an account conducted in foreign currency held at an Authorised Dealer in South Africa
Not allocated
Not allocated
Donations to corporate entities - fixed assets
Investment by a non-resident individual - other
Investment into property by a non-resident corporate entity
Disinvestment of property by a resident corporate entity
Gifts
Contributions in respect of social security schemes
Annual contributions
Contributions in respect of charitable, religious and cultural (excluding research and development)
Other donations / aid to government (excluding research and development)
Other donations / aid to private sector (excluding research and development)
Pensions
Annuities (pension-related)
Inheritances
Alimony
Tax - Income tax
Tax - VAT refunds
Tax - Other
Insurance premiums (non-life/short-term)
Migrant worker remittances(excluding compensation)
Insurance claims (non-life/short-term)
Foreign national contract worker remittances (excluding compensation)
Insurance premiums (life)
Not allocated
Insurance claims (life)
Not allocated
Adjustments / Reversals / Refunds related to income and yields on financial assets
Dividends
Branch profits
Compensation paid by a non-resident to a resident employee temporarily abroad (excluding remittances)
Compensation paid by a non-resident to a non-resident employee in South Africa (excluding remittances)
Compensation paid by a non-resident to a migrant worker employee (excluding remittances)
Compensation paid by a non-resident to a foreign national contract worker employee (excluding remittances)
Commission or brokerage
Rental
Interest received from a resident temporarily abroad in respect of loans
Income in respect of inward listed securities equity individual
Interest received from a non-resident in respect of individual loans
Income in respect of inward listed securities equity corporate
Interest received from a non-resident in respect of study loans
Income in respect of inward listed securities equity bank
Interest received from a non-resident in respect of shareholders loans
Income in respect of inward listed securities equity institution
Interest received from a non-resident in respect of third-party loans
Income in respect of inward listed securities debt individual
Income in respect of inward listed securities derivatives individual
Interest received from a non-resident in respect of trade finance loans
Income in respect of inward listed securities debt corporate
Income in respect of inward listed securities derivatives corporate
Interest received from a non-resident in respect of a bond
Income in respect of inward listed securities debt bank
Income in respect of inward listed securities derivatives bank
Interest received not in respect of loans
Income in respect of inward listed securities debt institution
Income in respect of inward listed securities derivatives institution
Income earned abroad by a resident on an individual investment
Not allocated
Not allocated
Proceeds for advertising and market research services
Proceeds for management consulting services
Proceeds for medical and dental services
Proceeds for cultural and recreational services
Not allocated
Not allocated
Proceeds for accounting services
Proceeds for managerial services
Operational leasing
Proceeds for public relation services
Proceeds for educational services
Proceeds for other business services not included elsewhere
Diplomatic transfers
Proceeds for financial services charged for advice provided
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FINANCIAL SERVICES PROVIDED
CONSTRUCTION SERVICES
GOVERNMENT SERVICES
STUDY-RELATED SERVICES
OTHER BUSINESS SERVICES RENDERED
D. TRANSFERS OF A CURRENT NATURE
FINANCIAL INVESTMENTS/DISINVESTMENTS AND PRUDENTIAL INVESTMENTS
CAPITAL TRANSFERS BY SOUTH AFRICAN RESIDENT INDIVIDUALS
E. TRANSFERS OF A CAPITAL NATURE
TRANSACTION ADJUSTMENTS
TRANSACTION ADJUSTMENTS
FINANCIAL INVESTMENTS/DISINVESTMENTS (EXCLUDING LOCAL INSTITUTIONAL INVESTORS)
INVESTMENT BY A NON-RESIDENT
DISINVESTMENT BY RESIDENT INDIVIDUALS
CAPITAL TRANSFERS AND IMMIGRANTS
TRANSACTION ADJUSTMENTS
CAPITAL TRANSFERS RELATING TO GOVERNMENT / CORPORATE ENTITIES (EXCLUDING LOANS)
CAPITAL TRANSFERS BY NON-RESIDENT INDIVIDUALS
DISINVESTMENT IN TERMS OF INVESTMENT ALLOWANCE
IMMIGRANTS
CURRENT PAYMENTS
C. TRANSACTIONS RELATING TO INCOME AND YIELDS ON FINANCIAL ASSETS
TRANSACTION ADJUSTMENTS
INCOME RECEIPTS
Bidvest Bank Limited (Reg No 2000/006478/06) is a licensed financial services and registered credit provider, NCRCP17.
Balance of Payment FormBank purchase from customer
Page 4/4
Insert “X” in applicable box
602
701
702
703
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705
701
702
703
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705
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707
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610
615
611
612
613
605
603
605
610
615
611
612
613
605
603
605
610
615
611
612
613
605
610
615
615
616
617
618
611
612
613
605
605
604
605
605
Investment into money market instruments by a non-resident
Options - listed
Futures - listed
Warrants - listed
Gold hedging - listed
Derivative not specified above - listed
Options - unlisted
Futures - unlisted
Warrants - unlisted
Gold hedging - unlisted
Derivative not specified above - unlisted
Not allocated
Not allocated
Disinvestment of shares by resident - agriculture, hunting, forestry and fishing
Inward listed securities equity individual buy-back
Disinvestment by resident institutional investor - Asset Manager
Inward listed securities debt individual redemption
Inward listed securities derivatives individual proceeds
Not allocated
Disinvestment of shares by resident - construction
Investment into listed bonds by a non-resident (excluding loans)
Disinvestment of shares by resident - mining, quarrying and exploration
Inward listed securities equity corporate buy-back
Disinvestment by resident institutional investor - Collective Investment Scheme
Inward listed securities debt corporate redemption
Inward listed securities derivatives corporate proceeds
Not allocated
Disinvestment of shares by resident - wholesale, retail, repairs, hotel and restaurants
Investment into non-listed bonds by a non-resident (excluding loans)
Disinvestment of shares by resident - manufacturing
Inward listed securities equity bank buy-back
Disinvestment by resident institutional investor - Retirement Fund
Inward listed securities debt bank redemption
Inward listed securities derivatives bank proceeds
Not allocated
Disinvestment of shares by resident - electricity, gas and water supply
Inward listed securities equity institution buy-back
Disinvestment by resident institutional investor - Life Linked
Disinvestment by resident institutional investor - Life Non-Linked
Bank Prudential disinvestment
Not allocated
Not allocated
Inward listed securities debt institution redemption
Inward listed securities derivatives institution proceeds
Not allocated
Disinvestment of shares by resident - transport and communication
Disinvestment of shares by resident - community, social and personal services
Not allocated
Disinvestment of shares by resident - financial services
Not allocated
1
1
1
1
1
1
2
2
2
2
2
1
1
1
1
1
1
1
1
5
1
2
2
2
2
2
2
6
2
3
3
3
3
3
3
4
4
4
5
1
1
1
4
4
4
7
9
1
8
10
INVESTMENT BY A NON-RESIDENT
DERIVATIVES (EXCLUDING INWARD LISTED)
DISINVESTMENT BY A RESIDENT CORPORATE ENTITY
INWARD LISTED INVESTMENTS
PRUDENTIAL INVESTMENTS (INSTITUTIONAL INVESTORS AND BANKS)
700 Adjustments / Reversals / Refunds related to derivatives
1
DERIVATIVES
TRANSACTION ADJUSTMENTS
800
801
810
815
830
831
832
833
834
835
836
816
817
818
819
820
803
802
804
805
Adjustments / Reversals / Refunds related to loan and miscellaneous payments
Trade finance loan drawn down in South Africa
Repayment by a resident temporarily abroad of a loan granted by a resident
Repayment of an individual loan to a resident
Details of payments not classified
Not allocated
Rand drafts/cheques drawn on Vostro accounts (Only applicable if no description is available)
Credit/Debit card company settlement as well as money remitter settlements
Not allocated
Not allocated
Not allocated
Repayment of a study loan to a resident
Repayment of a shareholders loan to a resident
Repayment of a third-party loan to a resident (excluding shareholders)
Repayment of a trade finance loan to a resident
Not allocated
Loan made to a resident by a non-resident shareholder
International Bond drawn down
Loan made to a resident by a non-resident third party
Not allocated
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1
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1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
F. LOAN AND MISCELLANEOUS PAYMENTS
TRANSACTION ADJUSTMENTS
LOANS (CAPITAL PORTION)
LOANS GRANTED TO RESIDENTS
LOANS REPAID BY A RESIDENT TEMPORARILY ABROAD
LOANS REPAID BY NON-RESIDENTS
MISCELLANEOUS PAYMENTS
Signature of applicant/authorised signatory
Submitted by(authorised dealer)
Checked by
Bank official signature
Documentary evidence as called for in the exchange control rulings has been viewed and endorsed, “Exchange Provided”.
Initials prepared by
Designation
Date
For and on behalf of
Exchange control approval Application no. Exchange control permission interms of Section of the Rulings
Description of other
DECLARATION
I, the undersigned , hereby declare that:
• I have read this document and know and understand the contents thereof;
• the information furnished above is in all respects both true and correct;
• the currency applied for will only be used for the specific purpose stated herein;
• the documentation presented in support of this application is in all respects authentic;
• I have been informed of the limit applicable to the above transaction and confirm that this limit will not be exceeded as a result of the conclusion of this transaction; and
• I consent to this information being provided to the South African Revenue Service and/or the Financial Intelligence Centre.
BRANCH DATE
STAMP