THIS PORTION IS TO BE COMPLETED BY THE ACCOUNT OFFICER
Ocer’s Authorization
Primary Account Ocer____________________________________________________________________________ Primary Ocer Telephone______________________________________________________________________
Ocer ID Number_____________________________________________________________________________________ Ocer Cost Center to Book L/C_____________________________________________________________
Underwriter_______________________________________________________________________________________________ Underwriter Telephone___________________________________________________________________________
Senior Approver_________________________________________________________________________________________ Team Email_____________________________________________________________________________________________
Billing: Debit Account, Preferred (specify Account Number)_______________________________________________________________________________________________ -or- Send Invoice
Fees Charged Issuance (Minimum $300) (Select One)
________________________Basis Points P.A. (360 Days)
-or-
$
______________________ Flat
in USD
$__________ Application Processing
$__________
Courier
$
__________
Messaging
$
__________
Other, Specify____________________________________________
Collateral for L/C (select one) Secured -or- Unsecured
If Secured, Select Only One Type: Cash (Account Number)________________________________________________________________________ -or- Same Collateral as Credit Line
Other (specify)_________________________________________ -or- Multiple Assets (specify)____________________________________________________
Syndicated Transaction? Yes No If Yes, Fronting Fee May Apply _______________ Basis Points -or- $______________ Fixed
Letter of Credit Type (select one) Financial Obligation -or- Performance Obligation -or- Other (specify)_____________________________________________
Auto Extend Upon Expiration Date? Yes No Credit Facility #__________________________________________
Note: Upon Auto Extension of the Original Terms, No Notice or Document Will Be Sent to the Beneciary. Extension Requires Credit Approval, Can Be Rescinded.
Applicant Tax Identication No____________________________________________________________________ Applicant NAICS Industry_______________________________________________________________________
Instructions: Step 1 - Forward Completed Form and Attachments to Credit Underw
riting, Step 2 - F
orward Signed Form Package to Trade.Services@Capitalone.com
THIS PORTION IS TO BE COMPLETED BY THE APPLICANT
All Information Must Be Typed or Printed
APPLICANT (Obligor and Capital One Client)
Company Legal Name______________________________________________________________________________
Legal Street Address
_________________________________________________________________________________
_________________________________________________________________________________________________________________
City, State__________________________________________________________________________________________________
Postal Code__________________________ Country_______________________________________________________
FOR ACCOUNT OF (Equals Applicant, Enter Only if Dierent from Applicant)
Obligor’s Subsidiary, Aliate, or Customer
_________________________________________________________________________________________________________________
Legal Street Address
_________________________________________________________________________________
_________________________________________________________________________________________________________________
City, State
__________________________________________________________________________________________________
Postal Code
__________________________ Country_______________________________________________________
Amount in Figures $_______________________________________________________________________________ Currency: U.S. Dollars -or- Other (specify)______________________________
Amount in Words_________________________________________________________________________________________________________________________________________________________________________________________________________
Final Expiration Date _____________________________________________________________________________
Auto-Extend. If Yes, Annually on Issuance Date Anniversary -or- Other Frequency (specify)
The Purpose of this Letter of Credit is (select one) Insurance Lease Support Performance Advance Payment Bid
Other (specify)___________________________________________________________________________________ Additional Description (If Any)______________________________________________________________
Application for Irrevocable Standby Letter of Credit
TO: Capital One, N.A.
Trade Finance Services
802 Delaware Avenue
Department IZ: 18056-0500
Wilmington, Delaware 19801
continued
capital.one
DATE________________________________________
The applicant below requests Capital One, N.A. issue an irrevocable standby letter of credit with terms as set forth below by:
Document via Courier -or- Electronic via Teletransmission—(SWIFT Full Details Format)
IN FAVOR OF (Beneciary)
Beneciary Legal Name_________________________________________________________________________
Legal Street Address
_______________________________________________________________________________
_______________________________________________________________________________________________________________
City, State
________________________________________________________________________________________________
Postal Code
_________________________ Country______________________________________________________
ADVISING BANK (of Beneciary)
Name_____________________________________________________________________________________________________
Branch Address
______________________________________________________________________________________
City, State
________________________________________________________________________________________________
Postal Code
________________________ Country______________________________________________________
SWIFT BIC
_____________________________________________________________________________________________
Note: Optional, if le blank, Capital One may select
Note Upon Auto Extension of the Original Terms, No
Notice or Document Will Be Sent to the Beneciary.
Extension Requires Credit Approval, Can Be Rescinded.
032119
CB-2684
This Letter of Credit shall be:
A. Drawn as
Standby (available by dra(s) at sight drawn on Capital One, N.A. accompanied by the following document(s))
1) Beneciary’s signed statement, r
eading as follows:
(Please indicate below the exact wording which is to appear in the statement to be presented with the dra(s). If additional space is required, attach a signed addendum.)
_________________________________________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________________________________________________________________
2) Other (if any) _____________________________________________________________________________________________________________________________________________________________________________________________
B. Select One:
Transferable Not Transferable
C. Partial Drawings are (select one)
Permitted Not Permitted
D. Special Instructions
(if any) _______________________________________________________________________________________________________________________________________________________________________
Check if additional terms or other attachments are included with this application.
This letter of credit will be subject to the international standby practices (ISP98) currently in eect.
This application is subject to the terms and conditions of a continuing agreement f
or Irrevocable Standby Letters of Credit, a Master Agreement
for Documentary (commercial) Letters of Credit, and/or other credit documentation governing the issuance and reimbursement of letters of
credit, as applicable, which has been furnished to the undersigned. The applicant’s signature below arms it has read and agreed to the terms
of the applicable agreement and by this application and by any agreement to which the credit is issued. The applicant agrees that letter of credit
administration is subject to the industry standards and practices selected above on this form. This application is signed by a duly authorized
representative of the applicant on the date specied herein.
This application may be amended by request of the applicant prior to letter of credit issuance by submitting either (1) an additional signed
application form that replaces this form or (2) a dra letter of credit signed by the beneciary and approved in writing by the applicant via
email to Trade.Services@capitalone.com or letter submitted to Capital One, N.A at the address rst set forth above. Amendments are subject to
approval by Capital One, N.A.
USA patriot act notice U.S. Federal laws require nancial institutions to obtain, verify, and record information identifying each person who opens
an account. Issuing the credit is considered opening an account that requires compliance with these federal laws.
In the event that Capital One, N.A. requires further information, the primary applicant contact is:
Applicant Contact Name, Title
____________________________________________________________________________________________________________________ Telephone Number_______________
E-Mail Address___________________________________________________________________________________________________________________________________________ Facsimile Number_____________________________
Applicant Authorization Signature, Including Attachments
_____________________________________________________________________________________________________________________________________
Applicant Name of Ocer or Authorized Representative and Title
_____________________________________________________________________________________________________________________________________
Applicant / Company Name
_____________________________________________________________________________________________________________________________________
Applicant / Company Street Address
_____________________________________________________________________________________________________________________________________
City State Postal Code Country
_____________________________________________________________________________________________________________________________________
Authorized Signature Date
To be completed by Loan Closing Department
Loan Closing Department Post Closing Approval
ACBS ALS
Disbursement Number_________________________________________________ Reviewed By___________________________________________________ Loan Closing Signature
Date
_____________________________________________________________________________ Telephone______________________________________________________
Capital One 299 Park Avenue, 14th Floor, New York, New York 10017
Subject to credit approval. Terms and conditions apply. Products and services are oered by Capital One, N.A., Member FDIC. © 2019 Capital One.
capital.one
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