Jewellery Loss Claim FormBurglary, Theft, Loss Or Damage Policy no. claim is being made under Email Address I / We the undersigned, do hereby give notice of a claim in accordance with the following particulars: - Name of Assured Address: Business Telephone No. Fax No. Are you VAT registered ?YesNo Date of loss Where loss occurred Nature of loss Please provide a brief description of the circumstances of the loss: In most cases of loss your Policy requires you to notify the Police, please provide the Crime Number and Police Station address: Please provide details of any other steps taken to recover lost items. Please note that if the loss occurred when your property was either in the post or with professional carriers you must immediately (before contacting Towergate London Market Limited) advise the Postal Authority/ professional carrier and hold them responsible for the loss. PLEASE DETAIL OVERLEAF THE PROPERTY LOST OR DAMAGED IMPORTANT: In dealing with your claim we will act fairly and provide you with an efficient, courteous and effective service. We need also to point out that we may have Authority to settle straightforward claims on behalf of Insurers/Underwriters. In such circumstances we will indicate this is happening but we do need your consent to this situation where we are acting as agent for your insurers/Underwriters, not yourself, and we will therefore deal with your claim as if you were dealing with your insurers/Underwriters directly. However, you may choose to have your insurers/Underwriters make all decisions with us only holding the file and communicating Insurers/Underwriters decisions to you. We are proud of our service and hope you will choose to allow us to deal with your claim, but we need your consent to do this. Please tick one of the boxes below:- I consent to you dealing with my claim as an agent of my insurers/Underwriters (where applicable)*Yes I do not consent to you deciding my claim and request you to refer all matters to my insurers/UnderwritersNo We will if there are any matters of doubt/contention revert to referring all decisions to Insurers/Underwriters. I /We do solemnly declare that the property detailed overleaf, being solely my/our property or property for which I am /we are solely responsible and Insured under the aforesaid Insurance or Schedule attached thereto, was lost or damaged as aforesaid and I /we therefore claim the sum of £ as the amount due from Underwriters. I /We do also solemnly declare that there is no Insurance upon the said Property with any other Insurers effected either by me /us or any other person except as undermentioned *. Signed Dated this day (day) (month) (year) SCHEDULE OF THE PROPERTY LOST OR DAMAGED Note: As an alternative to scheduling the lost/damaged items you can attach a copy of the relevant part/s of your stock records with the items marked. Evidence of your stock records will usually be required so this will always assist. Description of items No. of items Date of purchased Cost Price £ Amount Claimed £ Total Amount Claimed
