Collectors Form

Name (required)
First Name	*
Last Name	*
Email (required)	*
Address
Country
Address Line 1 (required)	*
Address Line 2
City / Town (required)	*
Postcode (required)	*
Phone
Occupation (required)	*
Date of Birth (required)	*
Is the collection kept at the above address?
If no, please state address where it is kept:
Cover Required
Total Sum at the above address (£)
Total Sum in Bank Vault (Only) (£)
Total Sum Normally Bank (Bank vault, with a limit of 30 days out of the vault in a year, £)
Total Sum Anywhere Country of Residence (if not UK, £)
Total Sum Worldwide Cover
Value of top item (£) An individual stamp, block, pane, cover or postal history item. Having a market value of £2,500 or more will only be covered under this policy if seperately listed on the Schedule of Specified Items.

List items worth £2,500 or more
Collection Value Details
Has the collection been professionally valued ?
If "yes", by whom, and date of last valuation.
Date
If "No" on what basis was the value of the collection determined?
Is a complete record of collection maintained?
If "No" please state how exact amount of loss would be calculated?
Location Details - Is the address at which the collection is kept:
Self-contained and exclusively under your sole control ?:
Built of brick, stone or concrete or with walls of other incombustible or fire resistive material?
Are all external doors fitted with either a multi-point locking system or a 5-lever mortice deadlock
If NO or you are in doubt please give details of makes and types of locks fitted:
Are all accessible windows fitted with window locks having removable keys ?
Do you have a burglar alarm?
Is the collection kept in a safe, locked cabinet or fire-proof cabinet ?
If YES, please provide details
If "Yes", please state maximum amount NOT kept in safe, if applicable (£)
If NO, please provide details of where it is stored
Do you have any other forms of protection, i.e CCTV, Electronic Gates, Smoke Alarms etc. If YES, ple
Insurance History
Have you sustained a loss for any of the risks now to be insured against?
Is the collection presently insured ?
If "Yes"please state name of insurer:
Have you ever had your insurance cancelled?
Have you ever had your renewal refused?
Have you ever had your premium increased?
Has your insurance ever been revised with addition Terms & Increased rates?
On what date is this insurance to commence?
DECLARATION: To the best of my knowledge and belief the sums insured above represent the full value of the property to be insured. The information provided in connection with this proposal application, whether in my hand or not, is true and I have not withheld any material facts. I understand that non-disclosure or misrepresentation will entitle the insurers to void the insurance. I understand that the signing of the proposal/ application does not bind me to complete the insurance but agree that should a contract of insurance be concluded, this proposal/application and the statements made therein shall form the basis of the contract.
Date
Form Consent	This information will be stored and processed for the purpose of this enquiry and will not be shared, transferred or sold without consent. I understand and agree