Renewal - Valuable Articles

What is your first name? **

What is your first name? *

What is your last name? **

What is your last name? *

This field is hidden when viewing the form

Name

What is your full name?

What is your preferred phone number? **

What is your preferred phone number? *

Email*

What is your email address? *

What is the address where your valuable articles are kept? **

What is the address where your valuable articles are kept? *

Street Address Address Line 2 City State ZIP Code

Property types*

Select the types of valuable property you own. *

Jewelry
Fine Art
Silverware
Wine
Firearms
Furs
Other

Property Types Other

Please tell us about the other valuable property type(s) you own.

What is the total value of your jewelry collection? **

What is the total value of your jewelry collection? *

What is the total value of your fine art collection? **

What is the total value of your fine art collection? *

What is the total value of your silverware collection? **

What is the total value of your silverware collection? *

What is the total value of your wine collection? **

What is the total value of your wine collection? *

What is the total value of your firearms collection? **

What is the total value of your firearms collection? *

What is the total value of your furs collection? **

What is the total value of your furs collection? *

What is the total value of your collection of other items? **

What is the total value of your collection of other items? *

Valuables coverage

Are there specific items you would like coverage for?

Yes
No

How many items? **

How many items? *

Valuables description

Please provide a brief description and value of the items you would like to ensure are properly covered.

Description	Value ($)

Bank Vault

Are any of your valuable items stored in a bank vault?

Yes
No

What is the total value and type(s) of the items stored in a bank vault? **

What is the total value and type(s) of the items stored in a bank vault? *

Risk Management

Select the risk management strategies you use to protect your valuable property.

Permanently installed safe
Tracking sensors
Alarm system
Other

Risk Management Other

Please describe the other risk management strategies you use to protect your valuable property.

Appraisals

Do you have any recent appraisals for the item(s) you described?

Yes
No

Upload appraisal

Please upload your appraisal(s) for us to review.

Drop files here or

Max. file size: 128 MB.

Trust or LLC

Are any of your valuables owned by a trust or LLC?

Yes
No

Trust / LLC name

Please describe the property owned by the trust or LLC and provide the name of the trust or LLC.

Stored Off-premises

Are any of your valuable articles stored off-premises?

Yes
No

Storage Location

Please provide a brief description of the valuable articles that are stored off-premises and where they are kept?

Additional items?

Is there anything else you would like to discuss regarding valuable articles coverage?

File Upload

Please feel free to upload any other documents that will help us better evaluate your valuable collections. (I.e. Appraisals, condition reports, collection inventory, etc.)

Drop files here or

Max. file size: 15 MB, Max. files: 10.

Consent*

Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.

Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.

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Valuable Articles Evaluation

Ali (TEST) Jafarian

RiskRevu^TM Newsletter

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Valuable Articles Evaluation

Ali (TEST) Jafarian

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RiskRevuTM Newsletter

Contact

RiskRevu^TM Newsletter