Diisi oleh Bank (Filled by Bank)

PERMINTAAN PEMBUKAAN L/C IMPOR Application No.

APPLICATION FOR ISSUING IMPORT L/C Date : 20 Januari 2021
L/C No. :
Date :
Kepada / To
Adv. Bank :
PT BANK INTERNATIONAL
INDONESIA JAKARTA Business Unit :
Type of Margin :
Cash : ……….…… % Current A/C ..................... %
NCL : ….………… % Time Deposit ....................%

Swift / Telex / Mail *) Paraf :

Date :

Dengan ini Kami harapkan Saudara membuka Irrevocable Letter of Credit (L/C) untuk kepentingan
dan beban rekening kami menurut instruksi-instruksi sebagai berikut :
We herewith request you to issue on our behalf and for our account your Irrevocable Letter of Crredit ( L/C) in accordance with
the following Instructions :

1. L/C dibuka melalui bank penerus di MIZUHO CORPORATE BANK, LTD HONGKONG BRANCH SWIFT CODE: MHCBHKHH
L/C opened through advising bank in :

2. Jenis L/C : Sight □ Standby □ Transferable 3. Dibuka dengan / Issued by : 4. Tgl. & Tempat Berakhir: 20 April 2021, HONGKONG
L/C Type
√ Usance □ Usance Payable at Sight Swift / x Date & Place of Expiry

5. Mata uang & nilai L/C : U S D 3 3 , 4 0 0 . 0 0 6. Toleransi : Maksimum / Not Exceeding

L/C currency & amount Tolerance
□ Plus / Minus : ……… / .......... %
7. Penjual / Beneficiary : M A R U B E N I H O NG KO N G & SO U TH C HIN A LTD HO N G KO NG 8. Konfirmasi L/C / Confirmation L/C :
Alamat / Addres : 20/F,.TO W ER 1, ADM INIR ALT Y C EN T ER , 18 H AR CO U RT RO AD, HO NG KO NG Tanpa / Without √ Dengan / With
□ Boleh ditambahkan / May Add
8. L/C tersedia pada Nominated bank : Bank manapun □ .....................................................
L/C available with Nominated Bank Any bank

Untuk / For : □ Pembayaran Sight √ Negosiasi □ Akseptasi Wesel □ Pembayaran Tertunda Tenor ...........................................................
by Payment at Sight by Negotiation by Accetance of draft by Deffered Payment

9. Atas penyerahan draft beneficiary yang ditarik atas kami untuk 5 % dari nilai Invoice, dibuat atas order Bank MIZUHO CORPORATE BA NK dan disertai dokumen
Againts presentation of beneficiary's draft drawn on us for …….. % of the invoice value, made out to the order of Bank ........................and accompanied with documents :

a. Invoice yang ditandatangani, rangkap : …………4 FOLDS ……………………………..…… c. Asuransi : Policy / Certificate / Cover Note *)
Signed commercial invoice in folds Insurance

b. Dokumen Pengangkutan / Transport Documents , rangkap / Folds : …………………… d. Sertifikat / Certificate : Origin / Analysis / Health *)
√ Ocean/Marine Bill of lading " on board " tanpa catatan (clean) □ ....................................
Clean On Board Ocean / Marine Bill of Lading
□ Udara / Darat / Kereta Api / Jalan air dalam negeri *) e. Dokumen lainnya / Other documents :
Air / Road / Rail / Inland Waterway transport *) √Daftar Kemasan Daftar Timbangan □
□ Angkutan Multi Modal / Combined Transport Paking List Weight List

□ …………………….……………… □ ……………………………………
Consignee : □ to the order of Bank Mandiri □ ………………………………………. □ ……………………………………
Marked Freight : Prepaid / Collect *) Notify Party ................................................................................................................
12 Contract /Order No. : T M180611-01………………… 13. Syarat Penyerahan : □ FOB / CFR / CIF *) ...................... ( INCOTERM 2000 )
Contract No. Terms of deliv ery
Tempat / Place : INCOTERMS 2020 (NEW ONE)
14. Uraian barang / Description of Goods

a. Nama barang / Name of Goods POLYESTER STAPLE FIBRE ........................................................................................................................................................................................

b. Jenis barang / Type of Goods 7D X 51MM HOLLOW CINJUGATED .......................................................................................................................................................................................
c. Mutu barang / Quality of Goods RECYCLED ..............................................................................................................................................................................................................................
d. Kuantitas barang / Quantity of Goods : 20.000,00 KG S …………………………………………………..…… g. No. Pos Tarif ( HS no. ) .................................................

e. Harga Satuan / Unit Price : U S D 1 . 6 7 / K G …………………………….. 15. Tarif : Bea Masuk : ..…...……... % PPh psl.22 ...................%
Customs duty Income tax art.22
f. Harga / Price : FOB / CFR /... ……. *) : ……………………………………………………….. PPN : ……………. % PPnBM ...................... %
Value Added Tax Sales tax of luxury goods

16. Dikapalkan dari A NY P O RT IN T HAILA ND Tujuan ke JAKARTA, INDONESIA ................. Pengapalan terakhir M ID FEB R U AR Y 2 021
Shipment from Destination to Latest Shipment Date

17. Pengiriman sebagian : Diperkenankan / Tidak Diperkenankan *) 18. Pindah Kapal : Diperkenankan / Tidak diperkenankan *)
Partial shipment : Permitted / Not Permitted *) Transhipment : Permited / Not Permitted *)

19. Negara Asal / Country of Origin : H O N G K O N G ……………………………………. 20. No. Import reference ...............................
23. Asuransi ditutup pada : JAKARTA oleh : M A R U B E N I H O N G K O N G & S O U T H C H I N A L T D Kondisi
Insurance covered at by Conditions

24. Biaya-Biaya : □ Biaya di luar Indonesia beban beneficiary □ ...........................................................................

Charges Charges outside Indonesia for the account of beneficiary

25. Penyerahan dokumen-dokumen dalam 21 hari setelah tanggal pengiriman namun masih dalam masa berlakunya L/C.
Documents to be presented at the latest within days after the date of shipment but within validity of the credit.

26. Importir / Applicant : P T A B C J A K A R T A NPWP .............................................................................

Alamat / Address : J A KA RTA ……………………………………………………………...…… API-P / API-U ...............................................................
……………………………………………………Telp (021) 52009795 ....

Kami menyetujui bahwa terhadap pembukaan L/C tersebut di atas tunduk pada Syarat-Syarat Umum Bank Saudara untuk pembukaan L/C dan segala
biaya yang timbul karena pembukaan L/C ini menjadi beban kami.
We agree that this L/C issuing will be subject to your general terms and conditions for issuing L/C and all charges incurred in issuing of this L/C will be borne by us

…. …………………………………………………
Tanda tangan dan Cap Importir
A/C No. : ………………………………………….. Importer's Signature & Chop

Materei

*) coret yang tidak perlu / C ross unnecessary item ………. ...................................................................

Instruksi tambahan di lembar terpisah (jika ada) yang merupakan bagian dari aplikasi ini harus ditandatangani oleh importir.
Additional instructions at separate sheet (if any) which is one unity of this application should be signed by Importer.