Scheduled Personal Property Coverage Application
Please read Coverage for Jewelry, Silverware or Furs before completing this application.
Name and Address
Policy or Reference Number
Home Telephone
Work Telephone
To apply for this coverage, you must:
u
Obtain an appraisal of each item. Be sure to follow the Appraisal Requirements found in the back of this packet.
u
Take a photograph of each item.
u
Make a photocopy of your original purchase receipt for each item, if possible.
u
Print and sign a completed copy of this application. You may answer the questions on the computer before printing the
form or, if you wish, print the blank form and then write the information by hand.
u
Mail all of the above to:
Property Insurance Department
New Jersey Manufacturers Insurance Company
301 Sullivan Way
P.O. Box 728
West Trenton, NJ 08628-0728
Members of Household
Occupation
1.
2.
3.
4.
5.
If the person who received the appraisal is not listed above, please provide:
Name
Relationship to Applicant
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Date of Birth (mm/dd/yyyy) __________________________________
1.
Do you currently have or have you ever had fur, jewelry and/or silverware coverage with another insurance company?
r Yes
r No
If yes, which company?
For how long?
2.
If you sustained any losses during the past five years, provide the date and the payout amount of each claim and explain the
details. (Attach an additional sheet of paper if necessary.)
3.
Has any insurance company cancelled, refused to renew or declined the issuance of fur, jewelry and/or silverware coverage for
you? r Yes
r No
If yes, which company?
4.
Reason
What is the desired date of coverage?
Please list the articles to be insured. An up-to-date (not older than one year) appraisal must substantiate the value of each article.
(Additional articles should be listed on a separate sheet.)
Article
Appraised Value
Description
I certify that the above statements are accurate. I understand that: 1) This information will be used by New Jersey Manufacturers Insurance
Company if a loss occurs and NJM elects to replace or repair my lost valuables; and 2) Coverage will not become effective until NJM has
reviewed and approved the proper documentation.
I understand that any person who includes any false or misleading information on an application for an insurance policy is
subject to criminal and civil penalties.
Signature of Insured or Applicant
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Date (mm/dd/yyyy)
Appraisal Requirements
An appraisal completed within the last year meeting the following requirements must accompany each Scheduled
Personal Property Coverage Application. Additional appraisals will also be requested every several years to
make sure the scheduled items are insured to their current value. The appraisal must be from a jeweler
located within the United States, its territories, or Puerto Rico.
All appraisals require:
1.
Date;
2.
Name of the owner of the property;
3.
Complete description of the article, including comment on the quality;
4.
Appraised value, not including tax; and
5.
Signature, name, address and qualifications/credentials of appraiser.
The following should also be included with the appraisal as appropriate:
Fur - Type of article, lining, collar, sleeves, style, color, length and sweep; kind and quality of fur.
Silverware - Manufacturer and design; number of settings and/or pieces.
Jewelry - Manufacturer's name and model for watches and similar articles; weight, shape, cut, clarity and
color of fine stones (see below); description of mounting, pin, bracelet, etc. Loose gems are not eligible for
coverage.
STONE CHARACTERISTICS
Weight
Measured in carat (ct.) fractions, points (pts.), or millimeters (mm).
Example:
1 pt.
25 pts.
50 pts.
75 pts.
100 pts.
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=
=
=
=
=
.01 ct.
.25 ct.
.50 ct.
.75 ct.
1.00 ct.
=
=
=
=
=
1.0
4.1
5.25
5.75
6.5
mm
mm
mm
mm
mm
Shape
The eight most popular shapes available are illustrated below:
Round
Marquise
Emerald
Pear
Oval
Heart
Square
Baguette
Color
Color is most often described by either an AGS (American Gem Society)
or GIA (Gemological Institute of America) grading. The AGS grading ranges
from '0' to '10.' In contrast, the GIA uses an alphabetic scale from 'D' to
'Z.' The best gradings are designated by either a '0' or a 'D.'
Clarity
The degree of imperfection of a stone is usually measured by GIA grading
as shown in the scale below.
Flawless
VVS VVS VS
1
2
1
VS
2
SI si i i
2
1
2
1
FLAWLESS TO THE NAKED EYE IN VARIOUS DEGREES
IMPERFECT
(VISIBLE TO THE
NAKED EYE)
Cut
The cut indicates how well the stone reflects light and may range from ideal to too
shallow.
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