擔保提貨申請書

APPLICATION FOR ISSUANCE OF LETTER OF GUARANTEE FOR DELIVERING GOODS

日商瑞穗銀行股份有限公司	臺北分行	臺中分行	高雄分行	國際金融業務分行

Mizuho Bank, Ltd.	Taipei Branch	Taichung Branch	Kaohsiung Branch	Offshore Banking Unit Taiwan

日期

Date :

敬 啟 者
Dear Sirs：

申請人 Applicant	貨物名稱 Description of Goods
信用狀號碼 L/C No.	/ B/C BASIS	發票金額 Invoice Amount
船 名 Name of Vessel	提單號碼 B/L No.
船公司 / 代理商 Shipping Co / Shipping Agent

茲因有關上述貨物之提貨單尚未寄到，爰請 貴行惠予共同簽署擔保提貨證書一份，以便向船舶代理人申請准予提取貨物。

We enclose herewith for your countersignature our Letter of Guarantee addressed to the above-mentioned agent of the vessel calling for the subject cargo, as the Bill of Lading for which has not yet arrived.

貴行如因共同簽署擔保提貨保證書而蒙受任何損害時，申請人願負一切賠償責任，申請人確認無其他銀行涉及本交易，並預期 貴行將經由正常方式收到該提單，或由託運人直接寄送至 貴行。申請人同意於收到上項貨物之提單後，立即交付予 貴行或由 貴行代申請人交付予運送人或船舶代理人，以解除 貴行之保證書責任。申請人並同意全額投保前項貨物，並在 貴行之要求時，隨時提供投保證明予 貴行。貴行無須將押匯銀行所寄送之單據上之瑕疵再通知本申請人。

Regarding your countersigning the Letter of Guarantee, we hereby agree not to hold you responsible for consequences the may arise from your so doing, We confirm that no other bank is involved in this transaction and that it is expected that Bills of Lading either will be received by you in due course or will be sent to you directly by the shipper. We agree that, upon receipt of the Bills of Lading for the above shipment, we shall deliver the said Letter of Guarantee to you for cancellation or you may deliver the Bills of Lading directly to the shipping company or agents of vessel on our behalf to release you from such indemnity. We also agree to keep the cargo fully insured and will furnish proof of insurance at any time upon demand. You are therefore not requested to advise us of any discrepancy on documents received from the negotiating bank.

若運送文件有不符情事，申請人同意於匯票或付款通知提示時，無條件支付其所載款項，縱因貨物有任何瑕疵、短缺、不完整或其他問題亦同。倘申請人未就匯票或付款通知所載款項為付款， 貴行得隨時代為給付，申請人同意無條件立即向 貴行償付因此而支付之一切款項、利息及費用，絕無異議。

In case any discrepancy exist in the original shipping documents, we agree to unconditionally pay upon presentation any draft(s) or demand for payment covering the shipment even though the cargoes are defective, short of or incomplete or otherwise open to question. In the event we fail to make payment, you may at any time pay for account of us, and we agree to reimburse you unconditionally and immediately of all such payments made by you together with any other interest and expenses incurred therefrom without any disputes.

申請人依申請書之約定，對 貴行負有任何給付責任時， 貴行得就申請人之款項及對 貴行之一切債權為期前清償，並以該清償款項為抵銷。

Applicant (申請人) 申請人茲此簽署本申請書，並確認申請人確已收到，了解並同意 貴行與本交易相關一切之文件及資料。	Seal is omitted	when sending throughGlobal	Mizuho Global e-Banking _________________________________________ 申請人名稱（請蓋原留印鑑） Name and Signature of Applicant Affix the specimen signature seal registered with bank In the event that we are responsible for any payment to you under this application, you may set off and apply towards such payment any and all amounts held or any and all credits retained and early paid by you.

FOR BANK USE ONLY
核 章 LG NO.
實行日	主管	經辦
解除日	主管	經辦

(C3040) Electronic Application / Mizuho Global e-Banking Applicable 20141020

Note: 使用此申請書時，本人/本公司同意不更動除填記欄位以外之申請書內容及文字，若更動該申請書內容或文字而造成 貴行損失時願負一切責任。