BANK INSTRUMENT APPLICATION FORM
Ekens Security and Law Science Corp. 9002a Beauport, Lasalle, h8r-2e9 www.ekenssecurity.com ekens@ekensonline.com Application form for issuance of BG, SLOC, DLOC, POF, Covering Sea, Air, Road, Courier, Postal or Inland Waterway Transport. We request you to issue by one of the Bank Instruments above, by telecommunication in accordance with the instruction below, The credit is to be subject to the uniform custom and practices for (BG) (POF) (DLOC) of International Chamber of Commerce , Paris 2007 Publication. No. 600
Type of Instrument
Bank Guarantee Refers as (BG)
Proof of Funds refers as (POF)
Documentary Letter of Credit (DLOC)
Standby Letter of Credit (SLOC)
Type of Application
*
Irrevocable
Irrevocable Transfer
(Currency and Code
*
example $ USD
Face Value/Amount Requested
*
Agency Fee
*
Documentation Fee, Note: must be accompany with this application in order to process the preliminary approval from the lender, this is refundable if preliminary approval is not secured
*
Example $
Bank Instruments Leasing/% Fee
Example %
Evidence of funs to cover the requested instruments
*
Bank Statement
Covering Letter from local Bank
How do you intend to pay agency/Leasing fee %, Note: These payments are required before delivery of requested instruments
*
Escrow Account
By Wire Transfer
Cash Deposit
(Beneficiary Contact Name)
*
First Name
Last Name
(Beneficiary Company Name)
*
example xxx company limited
(Beneficiary E-mail
*
(Beneficiary Address)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
(Beneficiary Phone Number
(Beneficiary Bank Name)
*
example XXX Bank Limited
(Beneficiary Bank Address)
Street Address
Street Address Line 2
City
State
Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Beneficiary Bank Account)
example 12335-0098-00000
Beneficiary Bank Swift or BIC
*
example TTO-UUT-PPP-03R-000-XXX
Beneficiary Corresponding Bank or Clearing House
Beneficiary Corresponding Bank or Clearing House Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Available by
Sight Payment
Deferred Payment
Negotiable
Sight
Partial Shipment
Allowed
Not Allowed
Place of of Taking in Charge:
example Montreal, Quebec, Canada
Dispatch from:
example specify
Place of Receipt:
example specify
Means of Dispatch
By Truck
By Railway
By Air
By Sea
Delivery Terms
EXW
FCA
CPT
CIP: ICC:
ICC
Invoice or Agreement Date
*
-
Month
-
Day
Year
Date
Description of Goods and or Service: Please insert: also as per proforma invoice or contract no. and date etc.
Allowed Tolerance in Quality + %/ %
example specify %
Documents Reequipments
Commercial Invoice signed in original and Copy
Parking List in original and Copy
Certificate of origin original and Copy to be issue
Documents Countersigned by
*
On Official Authority Form A (GSP)
Chamber of Commerce
Beneficiary
Evidencing goods of origin
Beneficiary's Certificate stating that a copy each of commercial invoice and packing list as well
Original Certificate of Origin
Accompany the Goods
Additional Questions
FCR-Forwarders Certificate of Receipt
CMR-Road Transport Documents
Road Transport Document
Rail Transport Document
Courier Receipt, Post Receipt, Certificate of Posting
Inland Waterway Transport Document
Type of Insurance Policy
Insurance Policy
Insurance Certificate
In Duplicate, Blank Enclose, For 110 % of CIF/CIP Value, Covering the Following Risk
Institute Cargo Clauses, All Risk
Institute War Clauses
Stipulating Claims are payable in the currency of invoice and indicating a claims setting agent in the country of the applicant
Evidencing the dispatch of goods to
Marked Freight
Payable at Destination
Prepaid and Notify
Other Documents
Example, Specify
Additional Conditions
Presenting Bank must send documents to MSB as follows
In one lot by courier
In one lot by registered airmail
In two lots by registered airmail
Commission and Charges
All commission and charges, except those of the issuing bank, are for Beneficiaries account.
All commission and charges, those of the issuing bank and advising bank (=bank of beneficiary) are for Beneficiary's Account
All commission and charges are for Applicants Account
Documents to be presented within Date
-
Month
-
Day
Year
Date
Signature
Place
Date
-
Month
-
Day
Year
Date
Time
Hour Minutes
AM
PM
AM/PM Option
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