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Request a Quote For Art & Antiques

* Required

Application Contact Information

Prefix:

* First Name:

* Surname:

* Address 1:

Address 2:

* City:

* State / Province:

* Zip / Postal Code:

* Country:

* Citizenship:

* Country of Residence:

* Telephone:

Fax Number:

* E-mail:

 

Item / Collection * at least one item must be entered

How many items?

1.)

* Object

* Type

 

* Purchase Price and Date

* Insured Value

Insurance Company

Current Premium

* Last Date of Appraisal

2.)

* Object

* Type

 

* Purchase Price and Date

* Insured Value

Insurance Company

Current Premium

* Last Date of Appraisal

3.)

* Object

* Type

 

* Purchase Price and Date

* Insured Value

Insurance Company

Current Premium

* Last Date of Appraisal

4.)

* Object

* Type

 

* Purchase Price and Date

* Insured Value

Insurance Company

Current Premium

* Last Date of Appraisal

5.)

* Object

* Type

 

* Purchase Price and Date

* Insured Value

Insurance Company

Current Premium

* Last Date of Appraisal

6.)

* Object

* Type

 

* Purchase Price and Date

* Insured Value

Insurance Company

Current Premium

* Last Date of Appraisal

7.)

* Object

* Type

 

* Purchase Price and Date

* Insured Value

Insurance Company

Current Premium

* Last Date of Appraisal

8.)

* Object

* Type

 

* Purchase Price and Date

* Insured Value

Insurance Company

Current Premium

* Last Date of Appraisal

9.)

* Object

* Type

 

* Purchase Price and Date

* Insured Value

Insurance Company

Current Premium

* Last Date of Appraisal

10.)

* Object

* Type

 

* Purchase Price and Date

* Insured Value

Insurance Company

Current Premium

* Last Date of Appraisal

Please identify the appraisal company(s) used.

* Have you declared any claims in the past 5 years?

Yes No
If Yes, then please explain

* Have you been non-renewed, cancelled, or declined by an insurance company?

Yes No
If Yes, then please explain

* Does anyone else have a financial interest in any object?

Yes No
If Yes, then please explain

 

Location Information

* Address:

* City:

* State / Province:

* Zip / Postal Code:

* Country:

* Construction Type:

* Year Built:

* Square Foot:

* Fire System / Alarm:

* Security System / Alarm:

* Water Sprinklers:

* Safe (Wall, Floor, Freestanding):

* Is the residence left unoccupied for more than two weeks ?

Yes No
If Yes, then please explain

* Is the premise more than 1,000 feet from a fire hydrant, or more than 5 miles from a fire response station?

Yes No
If Yes to either, then please explain

Do you employ domestic help ?

Yes No
If Yes, then please indicate how many

   
 
   

PHONE: +1-866-510-0149

International Insurance & Investments LLC

1725 Washington Rd. · Suite 406
Pittsburgh, PA. 15241 USA

International Insurance & Investments LLC is licensed in the European Economic Area, Switzerland, The United Kingdom and the United States of America. In the USA, the firm is licensed in 17 states. In the United Kingdom, the firm is authorized and regulated by the Financial Services Authority # 315054.


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