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SCHEDULED PERSONAL PROPERTY SUPPLEMENT
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| NAME _____________________________ | POLICY # ________________________ | |||||
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This form is to be submitted only when additional space is required to schedule personal property. Subtotal by Class. Circle all classes that apply: |
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| 1. | JEWELRY | 2. | FURS | 3. | CAMERAS | |
| 5. | MUSICAL INSTRUMENTS | 7. | SILVERWARE | 8. | GOLF EQUIPMENT | |
| 9. | FINE ARTS | 10. | STAMPS | 11. | COINS | |
| 12. | FIRE ARMS | |||||
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# & CLASS
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DESCRIPTION |
BRK
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$ LIMIT
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| FORM #5261 (4/99) | |||
| WHITE ORIGINAL - HOME OFFICE / YELLOW COPY - INSURED / PINK COPY - SALES AGENT | |||