Submit A Claim

**If you are a first time user, please fill out the form below to submit a claim. A representative will contact you shortly to set you up in our system.

Adjuster Information
Name:*
First Last
Company Name:*
Office/Zone:
Supervisor Name:
Email (This will be your username)*
Phone*
Fax
Policyholder Information:
Name
First Last
State:
Zip Code*
ZIP / Postal Code
Email
Phone
Claim Information:
Claim Number:
Date of Loss:
Date Format: MM slash DD slash YYYY
Deductible:
Individual Limit:
Aggregate Limit:
Contact Insured*
- Contact Insured* (Recommended)
- Do Not Contact Insured
Replacement Items:
1. Scheduled Limit:
Item Description:
2. Scheduled Limit:
Item Description:
3. Scheduled Limit:
Item Description:
4. Scheduled Limit:
Item Description:
5. Scheduled Limit:
Item Description:

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- “I just want to tell you, I really appreciate all your help with this. I really had no idea where I should start. You’re making it a lot easier for me to find a replacement of my precious rings!”
  
  Michelle, 2018
- “I did pick up my necklace yesterday and it’s beautiful! I am very pleased with the replacement quality of the diamonds. Thanks so much for all of your help with this process. Much appreciated! I’m so happy to have my necklace back… I just felt sick in losing it.”
  
  Diane, 2018
- “I just wanted to thank all of you who worked on the replacement of my wife’s necklace. All of you have made this ordeal as smooth and as painless as possible. We got the replacement today and it is beautiful!”
  
  Cal, 2018
- “The earrings came in Tuesday night and I did not get a chance to open them until I got home. They are absolutely beautiful. I think these stones are prettier than the original stones. Thank you again for taking the time to visit with me & especially for the quality of work I have received from Artigem. You have been an outstanding company to work with!”
  
  Dianne, 2018
- “I just wanted to tell you how grateful I am for all your help. My grandmother’s ring looks so beautiful! Thank you for taking good care of it.”
  
  Rhonda, 2018

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Submit A Claim

Adjuster Information

Policyholder Information:

Claim Information:

Replacement Items: