Proposal Form-CICL Private Jewellery

Introduction

Jewellery Insurance You must take care in answering all the following questions which are relevant to us in providing this insurance and setting the terms and premium. Please contact us if you do not understand the question or the nature of the information required or please seek guidance from your insurance advisor. Failure to provide information or the provision of incomplete or inaccurate information may result in the loss of cover or a claim refused.

(Jewellery shall mean items created primarily to be worn for aesthetic or ceremonial purposes, including rings, gemstones, necklaces, watches, bracelets, chains, earrings, cufflinks, brooches, studs, piercings or ankle chains)

If you need any help with completing this form please do not hesitate to contact us via livechat, email or phone. - 020 7937 9092, enquiries@chelsea-insurance.co.uk

Full Name
Phone
Email
Address and Postcode
Date of Birth
Occupation
When would you like your cover to start?
Are you a resident of the United Kingdom?
Yes No
If No, please provide details
Have you or any other person living with you ever been convicted of, or have any prosecutions pending for any criminal offence (other than a minor driving offence)?
Yes No
If Yes, please provide details
Have you had any previous loss, theft or damage to jewellery in the last 5 years?
Yes No
If Yes, please provide details
(Cause of claim, date, value of the claim, insurer)
(Cause of claim, date, value of the claim, insurer)
Have you had any insurance coverage declined, cancelled or had increased or special terms imposed in the last 5 years?
Yes No
If Yes, please provide details
Do you travel for more than 30 days at any one time?
Yes No
If Yes, please provide details

Additional Proposer Information

In some cases (e.g.with engagement rings, gifts, collections) we suggest you have joint names on the policy, so either or both of you can discuss or renew the policy, add or remove items or make a claim. This avoids Data Protection issues.


Name
Address
Date of Birth
Occupation
Are you a resident of the United Kingdom?
Yes No
If No, please provide details
Have you or any other person living with you ever been convicted of, or have any prosecutions pending for any criminal offence (other than a minor driving offence)?
Yes No
If Yes, please provide details
Have you had any previous loss, theft or damage to jewellery in the last 5 years?
Yes No
If Yes, please provide details
Have you had any insurance coverage declined, cancelled or had increased or special terms imposed in the last 5 years?
Yes No
If Yes, please provide details
Do you travel for more than 30 days at any one time?
Yes No
If Yes, please provide details
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