(BANK NAME)

DAILY STATEMENT SHOWING THE INFLOW/OUTFLOW FROM

SPECIAL CONVERTIBLE RUPEES ACCOUNTS (SCRA)

FOR (DATE)

(Million Rupees)

Opening Balance         Total Credit During                      Total Debit During                            Closing Balances

The Period                                  The Period

Market    Inward      Sale       Dividend  Outward   Investment Tax &   Stamp                                          Market

Name of Account Holder Account Numbers              Value of  Remitt-  Proceeds   Received   Remitt-          in            etc.    Money                                        Value of

(SCRA)          SCRA    Shares/     ances         of         through      ances        Shares/                                          SCRA                Shares/

Securities                  Shares/    Designat-                   Securities                                                                 Securities

Securities   ed Bank

1

Total                                                   ------                  ...                                   .-

.. Figures less than 5,000