Bullion Express Limited, Bullion Purchase Form

Note that you will require a scan of your passport to attach to this application. Corporate applications will also require a scan of Certificate of Incorporation.

*You must complete all fields

Introducing Agent (If no-one, write Nil)*

Type of entity applying:* (eg individual, partnership, company superannuation fund, trust)

Name of entity applying:*

Identification Number:*(eg ID Card Number, Passport Number, Company Number, Tax File Number)

Delivery address of the entity applying:*

Email address of entity applying:*

Contact telephone number:*

Name of person completing form:*

In completing this Application Form you confirm and agree to the following things (please check each box):

	The money to be paid to the Company has not been obtained from any unlawful means, including but not limited to, any involvement in drug smuggling, gun running or money laundering.
	The money has not been obtained through a breach of any law in the jurisdiction that the funds originate from.
	In submitting this form you acknowledge having read the terms of the Bullion Express Limited Bullion Purchase Agreement available to read on this website and you agree to be bound by the terms of that Agreement.

Once we have received and processed your application, we will forward you a ‘pdf’ copy of the bullion purchase agreement for your signature and inform you of the bank account to which your payment may be sent. You will then need to scan and email (or fax) the signed agreement, and remit your contribution.

You must also provide the details of the remitting bank account (which is the account that return remittances will be sent to), as part of the application, due diligence and compliance procedures of the Company.

Account Name*
Account Number *
Bank Name*
Bank Address*
Swift Code*
Proposed transfer in US$*

Payment instructions and bank account details can be changed at any time by providing the Company with an email containing the details of the changed information at

Before submitting this form, you will need to obtain a scan of the identification page of your passport. The scan should be in a suitable picture format (.jpg) or in PDF format. The scan must be of sufficient quality, that the photo is fully recognizable. The form cannot be submitted without the file attached.

Attach passport scan *required

Attach certificate of incorporation (Corporate Applications)

Note: Submission may take a while depending on the size of the image scans