Name of the applicant

Address

Phone Number *

Fax

Email Address *

Contact person

Instrument Amount

Advising Bank

Name

Address

SWIFT CODE

Account number

Bank Officer

Beneficiary

Name

Address

Phone Number *

Fax

Email Address *

Beneficiary Approved Issuance Facility

Validity

Transaction Description

Merchandise Description

Pro Forma Invoice/ Contract Number

Date

Special Conditions

Sending instrument Via

SWIFTCOURIERTELEX

If by Courier, please fill out below:

Beneficiary Contact Peron

Full address

Phone

Email

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