Jewelry/Furs/Fine Arts

We accept requests for quotes only from licensed agents or brokers. However if you are interested in an Insurance Quote please contact us (E-MAIL, PHONE, FAX) and we will refer you to a licensed broker near you.
- Agency Name
- Contact Name
- Agency Account Nbr.
If you do not have an account with FTP complete and forward our
New Brokerage Account Questionaire

Select State in which the Risk is located:

QUESTIONS TO BE ANSWERED BY APPLICANT

1. Names of Applicant and of all members of household to which this Insurance applies, giving relationship to each other.


2. Residential Address


3. Occupation of all members of household, nature of occupation and business stated.


4. Business Address


5. Is Applicant or any member of his/her family (ie., Husband, Wife, Father, Mother, Son or Daughter) in any way connected with the theatrical or entertaining profession?
YES NO

6. Has Applicant sustained any Loss or Losses during the past three years which would have been covered under this form of Insurance if the Applicant had carried such a Policy?
YES NO

7. If so, state when such Losses occurred.


8. Was Insurance carried?
YES NO

9. If so, state Agency insuring same.


10. State fully circumstances and amount of Loss or Losses.


11. Has Lloyd's or any Company ever cancelled Insurance for Applicant or Husband or Wife of Applicant?
YES NO

11a. Has any such Insurance ever been refused?
YES NO

12. If so, give full particulars.


13. Is the property worn or carried solely by Assured?
YES NO

13a. If not, please state by whom.


14. If any of the property is worn or carried by women other that the Applicant, are any of them engaged in professional, mercantile or business pursuits?
YES NO

14a. If so, give full particulars.


15. If Husband and/or Wife are Applicants, do they reside together?
YES NO

16. Have any of the Applicants been divorced?
YES NO

17. If Single Person or Widow, state source of income.


18. For what amount do you propose to take out Policy? (Insurance must be for full value; if a valued Policy is desired a complete list of articles to be insured with values against each must be furnished with this application, such valuation to be made and signed by a qualified valuer.)


18a. Please schedule each item and value of each item here.


19. Is there any other material fact, within your knowledge, regarding this proposal of insurance, which should be submitted to the Insurers for consideration?


QUESTIONS TO BE ANSWERED BY BROKERS

1. Do you know the Applicant personally?
YES NO

1a. If so, for how long?


2. Did you receive the order direct from the Applicant?
YES NO

3. Do you handle other Insurance for the Applicant?
YES NO

4. Do you recommend Applicant?
YES NO

5. Approximate age of Applicants.


Thank You for submitting this risk.
We will be back to you with a Quote as quick as we can.

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