Application

PERSONAL DETAILS

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Title

Surname

Given Names

On behalf of (name of company if applicable)

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Postal Address

Poste Code

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Email Address

Phone

SIGNATURE OF APPLICANT

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Upload signature (copy)

Click or drag a file to this area to upload.

Signature Date (copy)

PRECIOUS METALS/PRECIOUS STONE/MONTHLY QUANTITY

Please tick (□) precious metal(s) required, include and indicate an estimated a monthly quantity

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Gold

Estimate of Monthly Quantity

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Silver

Estimate of Monthly Quantity

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Platinum

Estimate of Monthly Quantity

Please tick (□) precious metal(s) required, include and indicate an estimated monthly quantity

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Diamond

Estimate of Monthly Quantity

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Emmerald

Estimate of Monthly Quantity

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Ruby

Estimate of Monthly Quantity

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Sapphire

Estimate of Monthly Quantity

PRECIOUS METALS/PRECIOUS STONE/MONTHLY QUANTITY

Please tick (□) precious metal(s) required, include and indicate an estimated monthly quantity

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Gold

Estimated Contract Duration

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Silver

Estimated Contract Duration

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Platinum

Estimated Contract Duration

Please tick (□) precious metal(s) required, include and indicate an estimated monthly quantity

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Diamond

Estimated Contract Duration

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Rubby

Estimated Contract Duration

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Emerald

Estimated Contract Duration

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Sapphire

Estimated Contract Duration

FOR OFFICIAL USE ONLY

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Checkboxes

Verified

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Approved

REMARKS

PERMIT

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Description of Permit

Application Fee

$250.00 USD

2 Years / 5 Years

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Gold

2 Years

5 Years

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Silver

Field #100 (copy)

2 Years

Field #101 (copy)

5 Years

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Platinum

Field #100 (copy) (copy)

2 Years

Field #101 (copy) (copy)

5 Years

Layout (copy) (copy) (copy)

Diamond

Field #100 (copy) (copy) (copy)

2 Years

Field #101 (copy) (copy) (copy)

5 Years

Layout (copy) (copy) (copy) (copy)

Platinum

Field #100 (copy) (copy) (copy) (copy)

2 Years

Field #101 (copy) (copy) (copy) (copy)

5 Years

Layout (copy) (copy) (copy) (copy) (copy)

Emmerald

Field #100 (copy) (copy) (copy) (copy) (copy)

2 Years

Field #101 (copy) (copy) (copy) (copy) (copy)

5 Years

Layout (copy) (copy) (copy) (copy) (copy) (copy)

Rubby

Field #100 (copy) (copy) (copy) (copy) (copy) (copy)

2 Years

Field #101 (copy) (copy) (copy) (copy) (copy) (copy)

5 Years

Layout (copy) (copy) (copy) (copy) (copy) (copy) (copy)

Sapphire

Field #100 (copy) (copy) (copy) (copy) (copy) (copy) (copy)

2 Years

Field #101 (copy) (copy) (copy) (copy) (copy) (copy) (copy)

5 Years

FEES FOR PAYMENT

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Payment Option

SWIFT OR WIRE TRANSFER

Payment instruction will be provided in our invoice as well as other payment information and must be respected within 24 hours from the time of issue. Failure to do so will result in a cancellation of the contract and archive of any further communication.

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Signature

Click or drag a file to this area to upload.

CEMAC BUYER’S PERMIT

ONLINE APPLICATION FORM

PERSONAL DETAILS

SIGNATURE OF APPLICANT

PRECIOUS METALS/PRECIOUS STONE/MONTHLY QUANTITY

PRECIOUS METALS/PRECIOUS STONE/MONTHLY QUANTITY

FOR OFFICIAL USE ONLY

REMARKS

PERMIT

Description of Permit

Application Fee

$250.00 USD

2 Years / 5 Years

FEES FOR PAYMENT

Payment Option

SWIFT OR WIRE TRANSFER