Gemstone Loan Enquiry

Gemstone Loan Application Form - Comprehensive Details

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Section 1: Client details

Applicant/borrower full name

Company name (if applicable)

Registered address

Registered address

Registered address

Registered address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country

Country

Registered address

Correspondence address

Correspondence address

Correspondence address

Correspondence address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country

Country

Correspondence address

Nationality/Country of residence

Date of birth

Company registration number

Passport/ID number

Contact telephone

Email address

Occupation

Nature of business

Are you the legal owner of the gemstone(s)?

Yes

No

If no, please provide relationship to the owner

Purpose of the loan (brief description)

Would you consider selling the stone(s)?

Yes

No

Source of wealth/Origin of the gemstone(s)

If you are human, leave this field blank.

IntaCapital Swiss SA,
Rue du Rhône 80 - 84,
CH - 1204 Genève,
Switzerland