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Account Information
Account Name
Business Registration No.
Full Name
Designation
Email Address
Mobile Number
Tel Number
Fax Number
Full Address
Country
Same as above
Billing Address
(If different from Above)
Country
Business Entity
Individual
Sole Proprietorship
Partnership
Corporation
Others
Business Type
Individual
Manufacturer
Wholesaler
Retailer
Others
Product(s)
Colored Stones
Finished Jewelry
Loose Diamonds
Watches
Others
Additional Contact Details
Shipping Department
Contact Person
Mobile Number
Tel Number
Email Address
Same as above
Billing Department
Contact Person
Mobile Number
Tel Number
Email Address
Shipping Pattern
Countries where your business:
Export To
Import From
Avg Number of Package
Day
Week
Month
Year
Avg Value Per Package(USD)
Max Value Per Package(USD)
Shipping History
List All Losses in Past 3 Years
Description of Claim / Lost / Damage
Year
Carrier
Value Insured
Amount Claim Paid by Carrier
Business Reference
List 2 Business References
Company Name
Person Name
Years Known
Tel Number
Email Address
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