Touchstone Insurance Agency
PERSONAL JEWELERY INSURANCE APPLICATION
Application for Personal Jewelry Insurance with Touchstone Insurance Agency.

To be completed by applicant. Jewelers are not agents of Touchstone Agency or the insurance company. This application is a general application and can be used for an insurance policy to repair or replace your jewelry with like kind and quality or pay the cash value upon a loss of the jewelry articles insured.
For Internal Use
Quote Number  
Insurance Company  
Application Number   WA0008072
For coverage to be effective, you must include the following:
  • Completed application
  • Check or credit card payment for the premium amount
  • Uploaded, Faxed or Mailed copy of appraisal/jewelry insurance evalution for EACH item

Once you have filled out the application you can click the "Confirm and Review Button" below; once you have reviewed your information you can submit this application instantly or you can print the application and mail or fax it to:
Touchstone Insurance LLC
PO Box 188
Northbrook, IL 60065-9861
Toll Free Fax 1-866-534-4357 • Toll Free Voice 1-866-725-1999

Subject to Underwriting; if sent via e-mail or fax, coverage will be effective on the date we receive the application and supporting documents/ appraisals or receipts. If mailed, coverage will be effective at 12:01 a.m. on the day following the postmark date stamped on the envelope. If you would like coverage to be effective on a later date, specify the date here: mm/dd/yyyy
Applicant Information
* First Name M
F
* Last Name
* Date of Birth mm/dd/yyyy
SSN
* Street
Apt Number
* City
* State
* Zip
* County
Enter your County
* Country
* Telephone (Home) #
Telephone (Work) #
Telephone (Cell)#
* Email
*Occupation
Employer
Please Mail Policy to:
Applicant
Co-Applicant
Gift-Do NOT notify person possessing jewelry until:
Date: mm/dd/yyyy
 
Co-Applicant/Person Possessing Jewelry
Copy Same Info same as Applicant
First Name M
F
Last Name
Date of Birth mm/dd/yyyy
SSN
Street
Apt Number
City
State
Zip
County
Enter your County
Country
Telephone (Home) #
Telephone (Work)#
Telephone (Cell)#
Email
Occupation
Relation to applicant
Employer

Premiums are calculated using residence where the Jewelry will be located;

Please select the location where the Jewelry will be kept:

Applicants address

Co-Applicants address

Should you wish to change the address where the jewelry will be kept in the future you need only contact us and we will update the records.
    Daytime telephone number we can reach you at for additional information:
Insurance and Applicant Information: All questions apply to both applicant and co-applicant and must be answered.
1. Have you ever applied for or do you now have an existing policy to insure jewelry? Yes No
If yes, what company(s)
2. Have you had any previous loss, theft or damage to any jewelry, either claimed or unclaimed (in the past three years)? Yes No
3. Have you ever been convicted of a crime other than a traffic violation? Yes No
4. Briefly describe the construction of your residence (e.g. wood frame, masonry, etc.)
5. Do you live in a: Single family home Condominium Apartment Town home or other
Security Information: We recommend that your jewelry be kept in a locked home safe, secured hiding place, or safe-deposit box when not being worn.
1. Do you have a safe at your residence? Yes No
Approximate weight (Lbs): Is it anchored? Yes No
2. When you are not wearing your jewelry, is it stored in a safe? Yes No
If no, where is it stored?
3. Do you store any jewelry in a safe-deposit box? Yes No
If yes, provide name and address of safe-deposit box location and list items stored at this location (use separate sheet if necessary).
4. Does an alarm system protect your residence? Yes No
If yes, is it: Local alarm Police station Central station
Premium

For a Quote from GemShield:

If you would like a Gem Shield Policy (this policy is generally faster to implement), select GemShield and continue to fill out the application.This Policy's Primary Purpose is the Repair or Replacement of the jewelry Insured in the event of loss or damage. Please be sure to check the box below if you wish to have a deductible. Please indicate the amount of the deductible. We will issue a GemShield Policy (subject to Underwriting).
GemShield will send you back to your jeweler / appraiser in the event you have a loss or require repairs. GemShield will pay to have your jewelry article replaced or repaired in the event of loss or damage.


If you want to see a quote for GemShield Please fill in the eight required
fields, enter the total value of the jewelry to be covered, please determine
if you want a deductible, and if so, the amount of deductible (deductible
amounts are per instance of loss or damage not per item). You are under no
obligation to purchase insurance by viewing the quote.

Click Here to select a more immediate GemShield Policy    


For a Quote from CHUBB:

For a quote from Chubb please click the Chubb button and continue to fill out the form and withhold deductible and payment information. This Policy’s Primary Purpose is to offer the cash value of the jewelry insured in the event of loss or damage. When you finish the Application please press the Submit button, and we will provide you with a Quote for the coverage you have requested. (Subject to Underwriting) Please be advised that if you are interested in the Chubb policy the minimum total value to be insured should not be less than $12,000. This minimum can be based on multiple articles of jewelry.

If you would like a quote for Chubb please fill out the form, indicate in
the Notes field when the best time to contact you would be and we will call
you with a quote. If you would like a quote immediately please give us a
call.



Click Here to select a Chubb Policy

Payment Options
Pay by Personal CheckPay by Credit CardPay by Virtual Check
 
Upload Supporting Documents
Upload a copy of the appraisal/jewelry insurance evalution for EACH item.
Also, you can Upload images of the items you want to cover with this insurance policy application:

1) Browse File :
2) Browse File :
3) Browse File :
4) Browse File :
5) Browse File :
 Notes about the file:


We can accept an Invoice to process a GemShield Policy
File size maximum 3MB can be uploaded. For larger files, Please fax them.

This general application is from Touchstone Insurance LLC* and additional information may be required by the Underwriter. This application is for an insurance policy for one of the following purposes; either to repair or replace your jewelry with like kind and quality, or pay cash value, depending on the policy of the Underwriting Company selected. Please read your policy to understand the benefits and limitations. Filling out this application affirms you understand that as a part of the underwriting review process, the Underwriter may request credit reference checks and/or loss experience reports from appropriate agencies. It is a crime when a person knowingly and with intent to defraud or mislead: (1) files an insurance application containing false information, or (2) conceals information concerning material fact.


Read Privacy Policy:
Additional Notes: