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Certificate of Inward Remittance (CIR)

TIEZA form for certificate of Inward Remittance

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(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:
1.

2.
3.

4.

5.
6.
7.

Name of Remitter:
__________________________________
__________________________________
Global Custodian:
Yes
No
Country of Remitter:
__________________________________
Beneficiary of Foreign Currency Funds:
__________________________________
__________________________________
Remitting Foreign Bank:
__________________________________
__________________________________
__________________________________
Date of Remittance: (___/___/___)
Remittance/Telegraphic Transfer Ref. No.:
__________________________________
FX Received:
 Currency: ________________
 Total T/T Amount :________________
 Amount Utilized :_________________
 O/S Balance after this CIR
Utilization: ______________________

B. Converted FX into Pesos, with the following
particulars:
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:
_______________________________
e) FX Receiving Bank’s 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 client’s account

 The peso proceeds have been paid to the beneficiary under:
MC No.: ______________________________.
PCHC Ref. : ___________________________
CC No.: ______________________________.
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

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