Summary: REQUEST FOR FINE ARTS INSURANCE FOR ITEMS ON LOAN
This request should be in the Risk Management Office one (1) week prior to the date we are to provide insurance.
(Please fax to 982-2635 or send to PO Box 400205)
Accompanying this request should be a copy of any contract or agreement signed by the owner/lender in addition
to a complete itemized list of items in loan/exhibition with the owner's or an appraised value of each item.
Date of Request:
Period Insurance Required: From: To:
Dates In Transit: Leaving Owner: Arriving UVA:
Leaving UVA: Arriving Owner:
If being returned to anyone other than owner, provide name and address:
Date of Exhibition:
Location of Exhibition:
Contract/Agreement with list of items and their value attached?
Address and email: