To be completed on Customers Letter Headed Paper 1

LETTER of INDEMNITY FORM

REQUEST for DELIVERY WITHOUT THE ‘ ORIGINAL BILL of LADING’s Dated:

00.00.00

To : The owner, and/or Carrier, and/or Agent, and/or Charterer, and/or Master of the : SS/MV :
[ name of vessel ]

SHIPMENT DETAILS :
Bill of Lading #’s :
Number of Packages :
Commodity :

Marks & Numbers / Container Numbers :

Dear Sirs,

We declare that the above goods were shipped on the said vessel by Messrs : [ Name of Shipper
]
and consigned to ourselves but the relevant original bill of ladings have not yet arrived in our
possession.

We hereby request release of the said shipment / cargo without the production of the original bill of
lading to ourselves and/or our nominee, namely, : [ Name of party taking goods ].

In consideration of your complying with our request above, we hereby agree to the following terms:

1 ] To indemnify you, your servants, agents and any associated staff against any liability of loss, damage
and costs
of whatever nature you may sustain by reasons of delivering these goods to : [ Name of party cargo is to
be released to ]
in accordance with our request.

2 ] In the event of any proceeding being commenced against you, any of your appointed servants,
agents and the like, in
connection with the aforementioned shipment, we shall provide you or them with sufficient funds to
defend themselves
against all associated claims.

3 ] If the vessel, or any other vessel or property belonging to you or your appointed servants, agents and
the like should be
arrested and/or detained, or if the arrest or detention, thereof, should be threatened we shall provide
securities to cover all
costs of bail and/or arrest and/or detention and/or legal fee and/or any other related expenses required to
secure the release
of the vessel and/or property and/or persons involved, whether or not such claims may be justified or not.

4 ] The liability of each and every person(s) under this INDEMNITY shall be joint and/or several and shall
not be conditional
upon your proceeding first against any person(s), whether or not such person(s) are a party to or liable
under this INDEMNITY.

5 ] This INDEMNITY shall be instigated in accordance with ENGLISH law and each and every person liable
under this INDEMNITY shall at your request submit to jurisdiction of the High Court of England.

6 ] As soon as the original bills of lading for the above shipment becomes available we shall produce
them, duly endorsed, to
you where upon our liability under this INDEMNITY shall cease.

Yours faithfully

[ Authorised Signatory of applicant + Printed Name]

Revison # : 00 QF142
Revised : 00.00.00 LEV/11/01 [Doc’s]
To be completed on Customers Letter Headed Paper 2

For and on behalf of : [ Applicants Company Name ]

=============================================================
=============================

To be countersigned by approved BANK, if so requested:

We join in this undertaking / INDEMNITY agreeing to it’s terms & conditions.

[ Authorised Signatory + Printed Name and/or stamp of BANK ]

For and on behalf of : [ Bank Name & Location ]

Dated :

Revison # : 00 QF142
Revised : 00.00.00 LEV/11/01 [Doc’s]