OTI Bond APPLICATION

OCEAN TRANSPORTATION INTERMEDIARY (OTI)
APPLICATION

Please Check applicable: FF NVOCC PRC Rider
*ACCOUNT NAME:		*CONTACT:
DBA NAME IF ANY:		*EMAIL:
*ADDRESS:		*PHONE NUMBER:
*CITY:		*STATE:
*ZIP:
LIST ALL OPERATING BRANCHES:


*IRS NUMBER		*LICENSE NUMBER
*SCAC CODE:		*YEARS IN BUSINESS:

*E&O (ERRORS & OMISSIONS) INSURANCE CARRIER:
*LIMITS:		*RENEWAL DATE:
CARGO LEGAL LIABILITY INSURANCE CARRIER:
*LIMITS:		*RENEWAL DATE:
*MARINE CARGO INSURANCE PROVIDER:
*LIMITS:		*RENEWAL DATE:
*IF OTHER THAN IB&M PLEASE PROVIDE FOLLOWING RENEWAL DATES CURRENT CUSTOMS BONDS ON FILE:
LIMITS:		RENEWAL DATE:
CURRENT OTI BOND PROVIDER:
*FREIGHT FORWARDING BOND:
LIMITS:		RENEWAL DATE:
*NVOCC BOND:
LIMITS:		RENEWAL DATE:

PLEASE SUBMIT CURRENT AUDITED FINANCIAL STATEMENTS. ALL FINANCIAL STATEMENTS ARE FOR UNDERWRITING PURPOSES ONLY.

*Name:

*Title:

*Date: