TO: Date:

Ref. No.:
BCI Ref. No.:

WE ENCLOSE THE FOLLOWING DOCUMENTS FOR COLLECTION:

Draft No. Amount : Tenor: Credit our Acct. No.______________

Drawn on: By: . Remit proceeds to us by check

Please remit these documents to your correspondent in One Mailing or Please advance _________ % of draft amount
(Collecting bank name, if any) at ____________ % interest per annum .
This item is to be used as collateral to secure an
advance under existing agreements

DOCUMENTS TO BE SENT BY: AIRMAIL FIRST CLASS REGISTERED CERTIFIED COURIER OTHER

Documents Bill of Commercial Customs Consular Insurance Inspection Certif. Of Packing Slip Weight
Enclosed Lading Invoice Invoice Invoice Certificate Certificate Origin Certificate
ONE 3/3 1 ORIGINAL 1 ORIGINAL 1 ORIGINAL 1 ORIGINAL
MAILING ORIGINALS 3 COPIES 1 COPY 1 COPY 1 COPY

Covering Shipment of:

From: To:

Vessel:
In case of need. refer to:
PLEASE FOLLOW INSTRUCTION MARKED X

DELIVER Against Against Against Trust Hold for arrival

DOCUMENTS Payment Acceptance Receipt Of goods
Tel.
WHOSE AUTHORITY IS LIMITED TO
AII your charges as well as any other stamp taxes or other duties are to be paid by ASSISTING YOU IN COLLECTING THIS
CHARGES Drawee Us (THESE) ITEM(S). BUT NOT TO CHARGE
Do not waive charges All cable charges for account of drawee OUR INSTRUCTIONS EXCEPT WHEN
DULY AUTHORIZED BY US IN WRITING.

INTEREST Collect interest for any delay in payment at the rate of % per annum. SPECIAL INSTRUCTIONS :
& From To
DISCOUNT Do not waive interest All discount of % if paid by

Advise acceptance & Cable Hold accepted draft until

Maturity date by Maturity.
Airmail
FATE
Return accepted draft to us
Advise non-payment First Class Mail
Acceptance by

PROCEEDS Request proceeds by Wire Transfer Cashiers Check

IT IS UNDERSTOOD THAT YOU ACCEPT THIS ITEM FOR TRANSMISSION ONLY AND AT OUR RISK and that you are not
responsible for any act, neglect, default, failure, or insolvency or bankruptcy of any correspondent, agent or sub-agent, or losses
or delays occurring in the course of transmission.

THIS COLLECTION IS SUBJECT TO THE CONDITIONS PRINTED ON THE REVERSE SIDE AND TO THE UNIFORM
RULES FOR COLLECTIONS. INTERNATIONAL CHAMBER OF COMMERCE PUBLICATION No.522 (REV. JUN1995)

COMPANY NAME. ADDRESS & TELEPHONE No.

X__________________________ X__________________________
______________________________________________ AUTHORIZED SIGNATURE(S)

___________________________ ___________________________
__________________________________ PRINT NAME AND TITL.E