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Jewellery Loss Claim Form

Burglary, Theft, Loss Or Damage

I / We the undersigned, do hereby give notice of a claim in accordance with the following particulars: -


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:-

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 *.



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.