APPLICATION FOR BL SURRENDERED REQUEST

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Camellia Fax: 092-262-2332
SURRENDER REQUEST
TO: Camellia Line Co.,Ltd.
B/L No
Vessel & Voyage No:
Dear Sirs,
We, the authorized agent of the shipper and the consignee, hereby request that you issue
the surrendered Bill(s) of Lading and deliver the above cargo to
(Consignee's name and address; )
without production of the original Bill(s) of Lading.
In consideration of your complying with our above request,we hereby agree as follows:
1. To deem the above Bill(s) of Lading in its(their) original form were issued,delivered to us,
and surrendered to you.
2. That the terms and the conditions provided for on the face and back of attached form of
the Bill(s) of Lading including the "Law and Arbitration" Clause shall be applied to the above
carriage.
3. That this surrender requst shall be governed by Japanese Law.
Best regards,
(Attached: back clause of a Bill of Lading)
Signature
Date
For and on behalf of
(Shipper's name)
and (Consignee's name)

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