Affiliation form Collection Focus

Please complete the form below to close a Collection Focus policy.

Click here for the features of the policy.

  • l. General information

    Pick your collection.

  • A permanent risk address is the place where the insured objects are located in the long term, such as a fixed residence, a second residence and children's residences.
  • ll. Declaration by the policyholder

    Please contact us for a specialised quote if you cannot tick one of the following seven questions.

  • lll. Insured capital/premium (gross premiums, incl. 9,9% insurance tax)

    Tick the gross annual premium you want to pay for the insured capital of your works of art and collectibles.

  • lV. Insured capital/premium (gross premiums, incl. 9,9% insurance tax)

    Tick the gross annual premium you want to pay for the insured capital of jewellery.

  • V. Start date/maturity date

  • The start date may not be earlier than the date on which this form is sent. If it is earlier, the policy will automatically take effect on the date on which this form is sent. The duration of the policy is one year, with tacit renewal for a further year.
  • Vl. Listed objects

    Complete the list below to the best of your knowledge and as fully as possible, or attach a separate list to this affiliation form (preferably in Excel)..

  • Type (painting, sculpture, video, ...)ArtistDescription (title, size, date, material, ...)Value (in euro) 
  • Type (porcelain, stamps, crystal, books, ...)Description (title, size, date, material, ...)Value (in euro) 
  • Type (jewels, diamonds, ...)Description (title, size, date, material, ...)Value (in euro) 
  • You can attach a separate list to this affiliation form (preferably in Excel).
  • Vl. Declaration

    The subscriber (acting in the name of and/or on behalf of the policyholder and all insured parties) declares, after investigation, that the information provided is correct and complete and that they have not knowingly omitted any facts. The subscriber accepts that this questionnaire and any additional information will serve as the basis for the insurance contract. The subscriber undertakes to inform the insurer of any changes to the present declarations immediately..

    With the exception of their situation requiring a specialised quote, the policyholder hereby expressly asks Art Secure by Vanbreda Risk & Benefits to draw up the policy using the start date mentioned above.

  • VII. On-site visit

    Upon Art Secure's simple request, Art Secure (whether or not with the insurer) reserves the right to view the listed insured objects within 30 days of underwriting the policy, or later if the appointment cannot take place during this period due to force majeure.

    Antwerp, October 2018.