Select the correct state:

Select the correct county:

2. Tell Us About Your Jewelry Item(s)

Jewelry Type

Value

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3. Choose Your Deductible

What is a deductible?

What is a premium?

valued at

* quoted premium based on location of wearer

DEDUCTIBLE

ANNUAL

PREMIUM

SELECT

Your Summary Total: $50.00 /yr

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Make sure you have the following:

Name and address of the jewelry wearer
Details about any alarm systems in his/her home
The appraised value or exact purchase price of the jewelry Documentation (receipt, appraisal, etc) is required.
You may apply without it, however you must submit the documentation within 10 days. As long as it shows the same value, your premium will not change.

Note: In order to protect your privacy, this application will timeout after 30 minutes of inactivity.

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Applicant & Wearer Information

Are either you or the jewelry wearer currently in possession of the items?
Does your jewelry need any maintenance or repair at this time?
For Massachusetts Applicants Only: Personal Information collected could be disclosed to a 3rd party without authorization. You have the right to access or correct any personal information collected. Our privacy notice will be furnished upon request.

1. Your Contact Information

First Name

Last Name

Address

Apartment/Suite

City

This is my mailing address

Mailing Address

Mailing Apartment/Suite

Mailing City

Phone Number

Email Address

Date of Birth

2. Who will wear the jewelry items?

valued at

Please provide information for the wearer of this jewelry item.

First Name

Last Name

Address same as primary applicant

Address

Apartment/Suite

City

Phone Number (optional)

Email Address (optional)

Date of Birth

Relationship to Applicant

3. In the last 10 years, have you or the person wearing the jewelry ever...

Been convicted of a crime other than a minor traffic violation?

Experienced any loss, theft or damage to your jewelry whether you made an insurance claim or not? (This includes any item that you want to insure.)

Date of Loss

Type of Loss

Amount of Loss

Date of Loss

Type of Loss

Amount of Loss

Add another loss

4. Important information about our website and your privacy:

Please review the Jewelers Mutual website Terms Of Use and Privacy Policy. In addition, to learn more about how Jewelers Mutual protects its customers' nonpublic personal information, including financial information, please read our "Notice to Policyholders: How We Protect Your Privacy" (Privacy Notice).

I agree to the website Terms Of Use and Privacy Policy, and I have read the Privacy Notice.

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Jewelry Details

Item Type

Serial Number (optional)

Why provide the serial number? It's important to us to assist in replacing your jewelry item in the event of a loss.

Please provide a brief description Please limit your response to 500 characters

Date of Purchase or Last Appraisal (optional)

You may proceed with your application, however the older your appraisal, the higher likelihood that your jewelry will be underinsured.

We recommend appraisals every 24 months for the most accurate replacement value.

Upload a receipt or appraisal (optional)

Select a File

Attached:

Do you have an active alarm system in your home?

When do you need coverage to begin?

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Additional Questions

Due to the value of your items, we require additional information.

1. Personal History

Have you or the person wearing the jewelry ever been cancelled or denied coverage by an insurance company?

Why? Please limit your response to 250 characters

2. Jewelry Storage

Do you store any jewelry in a safe-deposit box?

Name of the safe-deposit box location

Address Please limit your response to 250 characters

Do you live in a community with a gated entrance?

Does a fence surround the community?

Are there guards at the gate?

When are guards present?

Do you have community patrols?

What is the frequency of patrols?

How do you gain entrance to the community? Please limit your response to 250 characters

How do guests gain entrance to the community? Please limit your response to 250 characters

Do you employ domestic help?

What type of help?

How long have they been employed by you?

Do they reside at your home?

How often do they come to your home?

Does anyone other than you or the person wearing the jewelry reside at your home?

Who? (Please list names and relationship to Applicant) Please limit your response to 255 characters

How often is the jewelry worn?

3. Travel

How often do you travel overnight in a 12-month period?

Do you travel abroad?

What safeguards do you take to protect your jewelry while traveling?

Provide detail Please limit your response to 255 characters

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Payment

There is a fee for each installment up to $10 based on your state. Keep this in mind when selecting your payment plan.

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+ Add a Payment Method

Pay your bill automatically from the account above when payment is due.

Avoid lapses in coverage

Save time

Cancel anytime

Enroll me in Auto Pay. I authorize Jewelers Mutual Insurance Company to automatically charge the account above before each premium due date. I understand I can cancel Auto Pay at any time.

Submit Application

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Review Your Application

Applicant:

Item

Jewelry Wearer

Jewelry Details

Annual Premium

Item

value

deductible

Jewelry Wearer

Address same as Applicant

Jewelry Details

Appraisal Uploaded?

Alarm System?

Item Yearly Premium

Add another item

Discounts:

Add another item

Taxes & Surcharges:

Estimated Total Annual Premium:

Sign me up for paperless delivery. I authorize Jewelers Mutual to send billing and policy documents to me electronically. I understand that I can cancel at any time. I have read and consent to the Paperless Delivery Disclosure.

Submit Application

Continue to Payment

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An email will be sent to for your records.

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Create your online account.

From your account, you can:

Pay your bill

Add jewelry to your policy

Submit a claim

Upload documentation

Password

Your password must be at least 8 characters long and must contain at least one of each of the following:
• lower case letter
• UPPER case letter
• Number (1, 2, 3, etc.) or special character (#, $, ?, etc.)

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