TTF 5-Rev1/14

APPLICATION FORM

To:

CIMB Islamic Bank Berhad (671380-H)

Date / :
Your Reference / :
Our Reference / :
Related Trade Bill ref no / :

Please tick where applicable:

☐ TRUST RECEIPT-i (TR-i)

☐ FOREIGN CURRENCY TRUST RECEIPT-i (TR-i FCY)

☐ ACCEPTED BILLS-i (AB-i) IMPORT/PURCHASE

Dear Sir/Madam,

In consideration of us purchasing on your behalf the merchandise as per attached invoice(s), please effect payment to vendor / *credit our account no: with you being the cost of the said merchandise.

Cost of merchandise (Currency & Amount)
Currency In Words
Amount In Words
**Payable to

Foreign Exchange Rate contracted by us with your dealer (if applicable):

Currency / Amount / Rate / Contract / IDM no. / Dealer’s Name

We hereby authorise you to claim the merchandise at our premises / warehouse.

In the event that we have appointed you as our agent for purposes of facilitating the purchase of the merchandise by issuing a Documentary Credit-i, the said agency appointment shall be deemed to be revoked by me/us effective on the day prior to you effecting the payment as stated above and we agree and acknowledge that notwithstanding the said revocation, all fees which have been paid by us for the issuance of the Documentary Credit-i shall not be refunded to us.

We agree to abide and to be bound by the terms, undertakings, covenants and representations contained in your Letter of Offer and/or Facility Agreement to us.

*Enclosed herewith is proof of payment to the vendor.

**For Multiple Payment Instructions, please refer to the attachment.

Yours faithfully, / We hereby acknowledge the terms and conditions.
…………………………………….. / ……………………………………
(Authorised Signature(s) )
Company’s Stamp / (Authorised Signature(s) )
CIMB Islamic Bank Berhad

FOR BANK’S USE ONLY

Bank’s Ref. No / : ______
Approved By / : ______
Verified By / : ______

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