Jewellers Block Insurance

Section 01 of 07

Insured Details

Basic information about the business and its operations.

Business Identity

Insured / Trading Name *

Owner / Principal Name *

Years of Experience in the Jewellery Industry *

Previous Experience & Background Briefly describe prior roles, markets, or specialisations in the trade

Email Address *

Business Address(es)

Add each premises / store location separately. You can add up to 5 locations.

Operation Type

Type of Operation *Select all that apply

Retail Wholesale Manufacturer Repairs & Services Online / E-commerce

Years in Operation *

Number of Employees *

Section 02 of 07

Stock & Values

Provide accurate stock valuations — these directly determine your coverage and premium.

All values should represent your business stock only. Goods held in trust for others must be declared separately below.

Valuation Settings

Valuation Basis *

Cost Price Replacement Cost Other

Please specify valuation basis e.g. Market value, agreed value, depreciated cost

Currency *

Total Stock Values

Average Total Value — Last 12 Months *

AED

Maximum Total Value — Peak Period * State the rough period below

AED

Peak Period Description

Own Stock Value *

AED

Goods in Trust (Customer / Consignment)

AED

Nature of Stock (%)

Percentages must total 100%. Leave blank if not applicable.

Jewellery %

Precious Stones %

Bullion (Gold or Silver) %

Watches %

Other %

Total

Section 03 of 07

Premises Risk

Stock storage details during and outside business hours.

Values Outside Safe (Outside Business Hours)

Maximum Value Stored Outside Locked Safe * During non-business hours & temporary closures (e.g. lunch)

AED

Window Display

Average Total Value in Display Windows Leave 0 if no window display

AED

Showcase Protection

Are all showcases locked during business hours? *

Yes No

Are there any open display showcases? *

Yes No

% of Stock in Open Showcases

Average Value in Open Showcases

AED

Not easily reached by customers?

Yes No

Section 04 of 07

Security Details

Security measures directly impact underwriting. Please answer accurately.

Section 05 of 07

Carryings & Extensions

Coverage for stock carried outside the premises, home risks, entrustments and exhibitions.

Carryings of Stock Outside Premises (Employees)

Do employees carry stock outside premises? *

Yes No

Frequency *

Geographic Scope

Average Amount Per Employee Per Trip

AED

Maximum Amount Per Employee Per Trip

AED

Home Risk (Private Dwelling)

Does any principal/employee take stock to a private residence? *

Yes No

Reason for Home Risk

Address of Private Dwelling

Additional Information If stock is taken to more than one residence, please provide details of each address and reason

Entrustments (if coverage needed)

Stock entrusted to dealers, customers, repairers, cutters, setters etc.

Is entrustment coverage required?

Yes No

Estimated Total Value Entrusted (Last 12 months)

AED

Average Entrusted Value (at any one time)

AED

Maximum Entrusted Value (at any one time)

AED

Exhibitions (if coverage needed)

Is exhibition coverage required?

Yes No

Limit Required per Named Exhibition

AED

Number of Exhibitions (Next 12 Months)

Named Exhibition(s) / Jewellery Shows List the specific shows you intend to attend e.g. Jewellery & Watch Show (JWS), VICENZAORO, Basel World, Hong Kong Jewellery Show

Exhibition Location Scope * Select all that apply

Within country of insured only Outside country of insured

State Country / Countries of Exhibition(s) Outside Home Country List each country where exhibitions will be attended

Coverage at Venue Only?

Yes No — coverage required whilst insured interest is being transported to and from the exhibition venue

How will stock be delivered to exhibitions? e.g. Personal carryings, Transguard, Malca Amit, Brinks

Furniture, Fixtures & Fittings (if coverage needed)

Cover for the physical contents of the premises including display cabinets, shelving, counters, lighting, safes, and other fixed or loose fittings.

Is coverage required for furniture, fixtures & fittings?

Yes No

Limit Required * Total replacement value of all fixtures, fittings & furniture

AED

Brief Description e.g. Display showcases, safe, counters, fit-out

Section 06 of 07

Loss History

Honest disclosure is required. Non-disclosure may affect validity of coverage.

Claims in the Last 5 Years

Have you had any claims in the last 5 years? *

Yes No — no losses to declare

Year	Nature of Loss	Amount Claimed	Amount Paid	Status

Previous Policy History

Has any previous policy been declined, cancelled, or had special conditions imposed? *

Yes No

Please provide details

Section 07 of 07

Review & Submit

Please review all information before submitting. Your data will be used to calculate an indicative premium.

Declaration

By initialling and dating below, I confirm that all information provided in this proposal is true, accurate and complete to the best of my knowledge. I understand that any material misrepresentation or non-disclosure may render any policy issued voidable and may affect the validity of any claim.

I agree to the above declaration and consent to my data being processed for insurance purposes.

Initials * Enter your initials to confirm the above

Date * Date of signing this declaration

Proposal Submitted