保 結 書

LETTER OF INDEMNITY

致: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

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

日期：

Date

Dear Sirs,

In consideration of your negotiating at our request our Bill(s) of Exchange No.(s) for drawn on under Letter of Credit No. Issued By notwithstanding discrepancies between the documents presented and the terms of the said Letter of Credit in the following particulars, namely: (marked “X”)

茲因 貴行讓購附屬於以 銀行為開狀銀行，編號 之信用狀，由立保結書人所簽發編號為 號，金額 ，付款人為 之匯票，但有關文件之記載與前述信用狀之規定有下列不符之處：

（瑕疵具體內容）

Late shipment (Latest shipment date: )

L/C expired (Expiry date: )

Late presentation

Partial Shipment

Irregular Shipment

Overdrawn

We hereby undertake to indemnity you for whatever loss and/or damage that you may sustain due to the above-mentioned discrepancies.

立保結書人茲保證賠償 貴行因前述文件內容不符所受之任何損害及/或損失。

Yours faithfully,

FOR BANK USE ONLY

Ref. No.:
核章 Authorized Signature
支店長	副支店長	營業課	輸出入事務課	立保結書人簽署（請蓋用原留印鑑）
(Affix the specimen signature/seal registered with you) 申請人 Applicant:

(D4031) Electronic Application 20130701

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。