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  A Service of Supple-Merrill & Driscoll, Inc.




 Personal Articles Floater Application Instructions

  1. Please complete and submit this online application for a free, no-obligation quote.

  2. Please be sure to provide all required information in order to receive a quotation. 


  Program Information

This is a secure application.  Strong cryptography is implemented via the Secure Sockets Layer protocol.  Our Privacy Policy.

  PDF Application (Fillable)


( indicates required information)

Applicant Information

Full Name of Applicant:
Street Address:
City, State: ,
Zip/Postal Code:


We will never rent, sell, or share your email address.

Applicant Type:


Underwriting Questions

Any bankruptcy in the past 3 year?

Yes  No

Applicant confirms that shipments of Fine Arts or other fungible objects like coins, sports memorabilia and jewelry will not be sent via US mail:

Yes  No


Client Information


Description of Business/Operations:


Insurance History

Any insurance declined or cancelled in the past 3 years?

Yes  No

Any prior insurance coverage?

Yes  No

Any loss in the past 3 years?

Yes  No


Primary Location Details
Street Address:
City, State: ,
Zip/Postal Code:


Security Information


An alarm is required if the schedule is 100,000 or more.

Alarm Company:


A permanent, non-portable safe is required if the jewelry is 100,000 or more.


Coverage Options

Effective Date of Coverage:


Owned Equipment
Inland Marine


Out of Bank Vault

  Unscheduled Jewelry:

Unscheduled Jewelry allows for blanket coverage with a per item limit equal to the blanket limit

Fine Arts


Unscheduled Fine Arts:

Max $5000 Per Item

Unscheduled Fine Arts - maximum $5000 per items' allows for blanket coverage with a per item limit of $5,000 per item
Blanket Unscheduled Fine Arts:

Unscheduled Fine Arts allows for blanket coverage with a per item limit equal to the blanket limit.

Cameras, Projection Machines, Films, etc.:

No Commercial Use

Sporting Equipment:
Musical Instruments:


Postage Stamps:
Rare Coins & Collections:
Computers & Media:
Golf Carts:

Theft from Hotel or Motel Sub-Limit Endorsement:

For active athletes in professional sports as well as singers, a Theft from Hotel or Motel Sub-Limit endorsement will apply with a 50,000 sub-limit.  The sub-limit endorsement can be removed (providing coverage up to the limit for scheduled items) by selecting "up to Scheduled Limit" from the coverage drop down. A premium debit will apply.


Wind: Included
Terrorism: Included







Terms and Conditions

Please carefully review the Terms and Conditions below:

  • Please read all exclusions indicated on quotation.

  • The quotation received is not binding on the Insurer in any way.

  • By clicking 'Submit Application' you are not agreeing to purchase coverage.  Via email, you will receive a free, no-obligation insurance quotation.

  • 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. (Not applicable in CO, HI, NE, OH, OK, OR, VT). In DC, LA, ME, TN and VA, insurance benefits may also be denied.
  • Please note that once coverage is bound, the policy cannot be cancelled.

  • The insurance quotation will be based solely on the coverages and limits selected on this application.

  • Please ask your Supple-Merrill & Driscoll, Inc. representative to explain coverage details, exclusions, limits or other provisions of any insurance policy.

Type your name below, to indicate that you have read

and accepted the Terms and Conditions above:





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