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IQ Petroleum Intake Form



Download Word Intake Forms





Please understand the more information you can give us the easier it makes our job.  Our ability to sell you petroleum products and crude oils on a continuous basis, that meet your requirements depends upon the quality of information we receive from you as a potential client.


If you have favoured shipping lines, agents, or brokers or insurance companies please tell us about them:  or if you have your own standard additional questions that you ask for with the Q88, before acceptance of a vessel for FOB or CIF deliveries, let us know.

Payment will normally be on a shipment by shipment basis only or upon the assignment of a ‘lift schedule’.


Please read the following requirements on the next page carefully so we can comply with the new United States due diligence regulations.


Any questions about our services should be directed to IQ Petroleum.



We look forward to your early response so we can move your enquiry forward.


THANK YOU.         

 1.0  Due Diligence:

1.1 We are obligated under SEC regulations & Homeland Security (US Patriot Act – USAPA - Public Law 107-56) to ensure that we "know our client".

1.2 We require a copy of each instructing client's (or the instructing Director’s / Company Officer’s) passport to hold on file in order to comply with the regulations. 

1.3 We require a copy of your corporate registration certificate along with your address and communications numbers and addresses.

1.4 We require a brief profile of your company, preferably with a list of your professionals – accountants, legal advisors, insurance brokers, etc. 

1.5 We require a list of your current purchase capacity and simple details of your purchase history.

1.6 We require copies of your or your company’s last three year’s audited Accounts (Profit and Loss Sheets and Balance Sheet).

1.7 Please Note: The above data and any documents are held in complete confidence and would only be shown to an outside agency (government or otherwise) only if ordered to do so by court order issued within the legal jurisdiction of The United States.  At all times we exercise the same, or stricter, care of your details, data and documents as we would to our own confidential documents (see Data Protection below). 


Please Note:  Initially a copy of the company’s Certificate of Incorporation and the corporate profile are all we need.  We will deal with the rest of the pack as and when we put the offer to you.

2.0  Data Protection.

2.1 IQ Petroleum is committed to protecting your privacy. We do not sell, trade or rent your personal information to others.  We do not use or disclose any information that you may give us, such as your name, address, email address or telephone number, to any outside companies.

2.1 IQ Petroleum follows strict security procedures in the storage and disclosure of information which you have given us, to prevent unauthorised access. 

2.3 IQ Petroleum uses data provided solely for internal due diligence and compliance, and to fulfil your instruction.




Company Name :


Contact Name :


Address :




Tel :


Fax :


E-mail :




Corporate Registration & Registered Address:


Instructing Directors or Officers (name & address):



Instructing Directors or Officers (name & address):



*Lawyers (Name & address):


*Accountants (Name & address):


*Shipping Brokers (Name & address):


*Insurance Brokers (Name & address):


Don’t forget to attach the documents needed (see page 3).

  • are optional information





Buyer’s Name:


Bank Name:




Bank Officer’s Name:













Account Name:


Account Number:






Gas Oils & Diesels (Type)


Full specification sheet will be provided within contract

Origin :


Only if appropriate

Contract Quantity:


Total amount required

Duration of Contract:


Spot or how long the contract is to run.

Delivery Quantity :


Per load

Estimated First Delivery:


For FOB date at load port; for C&F or CIF date at discharge port



Choose only one

Load/Delivery Port(s) :


For FOB date at load port; for C&F or CIF date at discharge port

Price Basis:


Platts Assessment or Exchange or other formula

Target Price:


Fixed price or $ +/- against Price Basis

Payment terms:


Sight or number of days.

Payment Instrument:


Define type of instrument, e.g. DL/C SWIFT Cash, etc.

Any other information





Any special considerations:






Contact Us: Email  Sales@iqpetroleum.com  investments@iqpetroleum.com gasandoil@iqpetroleum.com

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