Par Is Documentary Collection Form

DOCUMENTARY COLLECTION ORDER TO : BLOM BANK France Collection Dept 38-40 Avenue des Champs Elysées 75008 Paris – France Dear Sirs, Please find enclosed the following documents on the terms and conditions stated here-below : Documents

Original

Copy

Invoice Bill Of Lading Packing list Certificate of origin Others Drawee : (full name and address) Amount of Documents : Covering : From : to : (In case of shipment by sea, name of vessel) : Please send these documents by express mail / registered mail / fax to the following collection bank with the following instructions : - (Full name and address of collecting bank) - Payment terms : deliver documents to the drawee against : (Cash against documents OR Acceptance of draft due on…OR Free of payment) Special Instructions : - This collection is subject to the Uniform Rules for Collections, publication no. 522 of the International Chamber of Commerce. - All Bank charges outside France are for the account of (ourselves OR the drawee ). - After receipt of the amount, kindly credit my account with you (A/C n°: proceeds. Signature

) for the net