Add/Change/Remove Item(s) on my Scheduled Articles Policy

Cameron A. Shandersky, CPCU

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Add/Change/Remove item(s) on my Scheduled Articles Policy

* Indicates required question

Full Name:

(Your name as it appears on your policy)

Your answer

Phone Number: *

Your answer

Email Address: *

Your answer

Date you want this change to be effective: *

YYYY

Add, Change or Remove item(s) *

(check all that apply)

Add Item(s)

Change Item(s)

Remove Item(s)

Required

Provide description & value of the item to be added, changed or removed from your Scheduled Articles policy *

(If multiple items, number each....No.1, No.2, etc.)

Your answer

* Items with value over $2,000 need some kind of documentation, usually in the form of an appraisal or receipt from the past 6 years.

Please email such documentation to cameron_shandersky@schiffinsurance.com
(You can even take pictures of the documents with your phone and email them. Thank you!)

Is there a loan on any new item? *

Yes

If "Yes" to loan, list the name & address of the loss payee:

(Example: Item No. 1 - General Electric Credit Union 10485 Reading Rd. Cincinnati, OH 45241)

Your answer

Notes or Special Instructions:

Your answer

Submitting this information IS NOT a Policy or Binder of Insurance. No coverage will be bound until you receive confirmation from us.

BY CLICKING THE "SUBMIT" BUTTON BELOW, I CERTIFY THAT THERE IS NO PRE-EXISTING CLAIM, LOSS OR CIRCUMSTANCE LIKELY TO LEAD TO SUCH A CLAIM OR LOSS FOR WHICH I AM APPLYING FOR COVERAGE.
WARNING: ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ANOTHER PERSON FILES AN APPLICATION FOR INSURANCE CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS THE PERSON TO CRIMINAL AND [NY: SUBSTANTIAL] CIVIL PENALTIES. IN TN, VA AND WA, INSURANCE BENEFITS MAY ALSO BE DENIED.
NOTICE TO OHIO APPLICANTS: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING HE/SHE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.

Questions? Contact:
Cameron A. Shandersky, CPCU
Schiff Insurance
P.O. Box 145496
Cincinnati, OH 45250-5496
P: 513.870.2580
cameron_shandersky@schiffinsurance.com

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Cameron A. Shandersky, CPCU
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