Jewellers/Pawnbrokers' Declaration For Insurance

NOTES FOR COMPLETION OF THIS FORM
  • Please answer all questions to the best of your knowledge. If a question is not relevant to your business,
    please answer ‘N/A’.
  • All material facts must be disclosed as failure to do so may nullify any insurance issued. (A material fact is one that is likely to influence the acceptance or assessment of this Declaration by Underwriters/Insurers).
  • If you are in any doubt concerning the answer to any question or to a material fact please contact us on 01702 544 972

NB All own stock figures in this Declaration must reflect the Basis of Value selected.

OUT OF SAFE LIMIT

This being the total value of the above in your Showroom, counters and windows at close of business). Note: It is a condition that such items in Pawn are required to be in Safe/Strongroom when closed.

WINDOW DISPLAY





TRAVEL Outside your premises please provide the following information:



























SENDINGS What was the aggregate total value of property sent during the last 12 months?



ENTRUSTMENTS






CLAIMS HISTORY

ADDITIONAL INFORMATION


DATA PROTECTION

Note Where Insurer is mentioned this shall mean Insurer/Underwriters

The defined terms used in this section shall have the meaning given to those terms in the Data Protection Act 1998 (as may be amended from time to time).

In the course of providing insurance services to you, the insurer may have access to Personal Data. You warrant that you shall have obtained all necessary authorisations and approvals from Data Subjects prior to disclosing any Personal Data to the insurer (whether such disclosure is made directly by you to the insurer or indirectly by you to any agent acting on behalf of the you or the insurer). The insurer shall be the Data Controller of any Personal Data provided to it.

The insurer undertakes that it shall only use any Personal Data provided to it for the purposes of performing its services in connection with its contract of insurance with you. This will include the processes of underwriting, administration and claims assessment as well as any necessary services ancillary thereto.

The insurer will hold all Personal Data provided to it securely and shall limit access to such Personal Data to those who have a need to see it. You hereby consent to the insurer sharing any Personal Data provided to it with its group companies, agents, reinsurers, claims handlers, loss adjusters, medical professionals and other professional advisors, healthcare management companies and any other necessary service providers with whom the insurer contracts in connection with the proposed contract/contract of insurance between you and the insurer

You acknowledge that the insurer may be required as a matter of law or regulation to disclose Personal Data provided to it to a Court of law or regulatory body such as the Financial Services Authority or any other public body or authority of competent jurisdiction and you hereby consent to any such disclosure.

You acknowledge that the insurance industry maintains certain registers for the purposes of fraud prevention and hereby consents to the insurer sharing Personal Data provided to it with fraud prevention agencies and other insurance companies for the purposes of fraud prevention and to validate your claims history.

DECLARATION

In completing this declaration, whether in my own hand or not, I have read and understood the questions and have checked the answers/information therein and confirm the answers are correct and complete. I understand that this is my responsibility and that any inclusion of incorrect information or the omission of material facts may entitle Underwriters/Insurers to void any insurance issued and/or repudiate claims.