公（  ）行收通字[    ]第   号

                                   案    由  __________________________________
                                   保证金交纳人 _______________________________
                                   金    额 ___________________________________
                                   收取银行____________________________________
                                   承 办 人 ___________________________________
                                   批 准 人 ___________________________________
                                   填 发 人 ___________________________________
                                   填发日期 ___________________________________

                                          存根