To,
The Manager, Forex / Trade Services
[Bank name], [Branch]

Subject: Quarterly declaration for closure of EDPMS entries (invoices up to ₹10 lakh), quarter [Apr–Jun 2027]

I/We, [Exporter name], [PAN], [IEC if any], hereby declare that payment against each export-of-services invoice listed below, each of value up to ₹10 lakh (or its equivalent in foreign currency), has been realised either in full or otherwise, as shown. We request closure of the related EDPMS entries in terms of the first proviso to Regulation 4(2) of the Foreign Exchange Management (Export and Import of Goods and Services) Regulations, 2026.

Sr | Invoice no. | Invoice date | EDF month | Currency & amount | Amount realised | Date realised | Bank ref / FIRA no. | Shortfall & reason
1  | [ ]         | [ ]          | [ ]       | [ ]               | [ ]             | [ ]           | [ ]                 | [ ]
2  | [ ]         | [ ]          | [ ]       | [ ]               | [ ]             | [ ]           | [ ]                 | [ ]

Where an amount is shown as realised short of the invoice value, I/we also request reduction of export value under the proviso to Regulation 6 and declare that the reasons stated are true.

I/We confirm that the above is true and correct and that supporting records are available for inspection.

Signature: ______________   Name: [ ]   Designation: [ ]
Place: [ ]   Date: [ ]