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Intimation to the Central Government of receipt of foreign contribution by way of gift from relative by an individual / Foreign Contribution in the form of Articles/ Securities/ by a candidate for Election [section 21 of the Foreign Contribution (Regulation) Act, 2010 (42 of 2010)]

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..... contribution by way of gift from relative: 1. Name of the recipient in full (in block letters): 2. Date of birth: 3. Name of Father/Husband: 4. Permanent address: 5. P.A.N, of the recipient in India: 6. Amount of foreign contribution received, if it exceeds ₹ 1 lakh or equivalent in a financial year: 7. Amount and the Number of the Bank Draft or telegraphic transfer or other communication including the Bank Details: 8. Income-tax registration number of the relative abroad and the name of the country of residence: 9. Name of the relative and relationship thereof, nationality and passport details: DECLARATION I hereby declare that the above particulars furnished by me are true and correct. Place: Date: Signature of the applicant (Name, .....

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..... hic transfer or other communication including the Bank Details: 8.Details of the relative: (a) Name: (b) Nationality (c) Country of residence (d) e-mail address (e) Passport Number (f) Relationship with the recipient DECLARATION I hereby declare that the above particulars furnished by me are true and correct. Place: Date: Signature of the applicant (Name, in block letters) Part B (To be filled by applicant giving intimation about Foreign Contribution (Articles) Account/ Foreign Contribution (Securities) Account) 1. Details of the applicant: (i) Name in full: (ii) Contact Details: (a) Address (b) Official Telephone No.(with STD code): (c) Official e-mail address (iii) FCRA Registration/Prior Permission number and date, if any (iv) PAN (Perma .....

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..... ame, address and e-mail address Individual Donor Nationality Relationship with donor Utilisation details (1) (2) (3) (4) (5) (6) (7) DECLARATION I hereby declare that the above particulars furnished by me are true and correct. Place: Date: Signature of the candidate (Name, in block letters) ] 4. Substituted vide Notification No. G.S.R. 695(E) dated 10-11-2020 before it was read as, 3 [FORM FC-1 [See rules 6, 17 and 18] The Secretary to the Government of India, Ministry of Home Affairs, Foreigners Division (FCRA Wing) Major Dhyan Chand National Stadium, India Gate, New Delhi-110002 Subject: Intimation to the Central Government of receipt of foreign contribution by way of gift from relative by an individual / Foreign Contribution in the form .....

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..... d by applicant giving intimation about Foreign Contribution (Articles) Account/ Foreign Contribution (Securities) Account] 1. Details of the applicant: (i) Name in full: (ii) Contact Details: (a) Address: (b) Official Telephone No.(with STD code): (c) Official e-Mail address: (iii) FCRA Registration/Prior Permission number and date, if any: (iv) PAN (Permanent Account Number) of the Association: (v) Aadhaar Number of the recipient in India (Optional): 2. Details of articles: Date Name of article (s) Description Name and address of the person from whom received Purpose Quantity Approximate Value (Rs.) Mode of Utilisation/ Disposal (if disposed to whom) (1) (2) (3) (4) (5) (6) (7) (8) 3. Details of securities: Date Nature of security received .....

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