APPENDIX 10.

1
(As amended by Circular No. 818 dated 06 November 2013)

CERTIFICATE OF INWARD REMITTANCE (CIR)

OF FOREIGN EXCHANGE NO. CCYY-NNNNN-BBBB
_________________
Name of Issuing Bank
TO THE BANGKO SENTRAL NG PILIPINAS:
Part I.
This is to certify that this Bank (mark applicable box/boxes):
A. Received an inward remittance of foreign
exchange (FX), with the following particulars:

B.

1. Name of Remitter:
__________________________________
__________________________________
Global Custodian:
Yes
No
2. Country of Remitter:
__________________________________
3. Beneficiary of Foreign Currency Funds:
__________________________________
__________________________________
4.
Remitting Foreign Bank:
__________________________________

8. a)

FX converted to Pesos:
Full Utilization of FX Received:
_________________________
__
Partial Utilization of FX
Received:
_________________________
__
O/S Balance after this
Utilization:
_________________________
__
b) Rate of Conversion Pesos per
Foreign
Currency
(before
charges):
_______________________
c) Amount of Peso Proceeds (net of
charges):
_______________________
d) Date Converted to Pesos:

__________________________________
__________________________________
5. Date of Remittance: (___/___/___)
6. Remittance/Telegraphic Transfer Ref. No.:
__________________________________
7. FX Received:
Currency: ________________
Total T/T Amount :________________
Amount Utilized :_________________
O/S Balance after this CIR
Utilization: ______________________

Converted FX into Pesos, with

the following particulars:

_______________________________
e) FX Receiving Banks Name (if other
than converting bank):
_____________________________
__
CIR
No.:________________________
T/T Ref. No.
____________________
9. US$ Equivalent (if foreign currency
remitted is other than US$):
_______________________________
__

Part II.
This is to certify that (mark and fill up applicable box):
The
said
peso
proceeds
were
___________________________________

deposited

with

this

bank

on

date the proceeds were credited to

clients account

The peso proceeds have been paid to the beneficiary under:

MC No.: ______________________________.
PCHC Ref. : ___________________________
CC No.: ______________________________.

IOD Form 03-002-04 * Version 2 * Updated 27 Nov 2013

APPENDIX 10.1
(As amended by Circular No. 818 dated 06 November 2013)
This certificate is issued for the sole purpose of obtaining a Bangko Sentral Registration
Document (BSRD) for the inward foreign investment of
____________________________ this
_________________.
Name and Nationality of Investor

Date of this

Certification
________________________________________________
Name of Branch/Department in Head Office

______________________________________________
Signature of Authorized Officer Over Printed Name

Contact Telephone No.: ___________________

Fax No.: ___________________

_____________________________________

IOD Form 03-002-04 * Version 2 * Updated 27 Nov 2013

Position