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Valued Inventory Form
Insured:
Telephone:
Fax:
Email:
Origin (City, Country):
Destination (Complete address):
Date Packed (mm/dd/yyyy):
Moving by: Land    Sea    Air

Instructions: Items not declared and valued are not insured.
A. LIVING ROOM
Articles No.
Items		 Replacement
Cost
Sofa(s)
Chair(s) - Ottomans
Lamp(s) & Shade(s)
Tables
Radio
Recorder Player/Stereo
TV(s), Video Recorder
Rug(s) & Carpet(s)
Piano/Other Musical Instr.
Tape Deck/Recorder
Bookcase/Room Divider
B. DINING ROOM
Articles No.
Items		 Replacement
Cost
Table
Chair(s)
China Closet
Buffet
Serving Table/Tea Cart
Lamps & Chandeliers
Rug(s) & Carpet(s)
Curtains & Drapes
Mirrors
Table/Linens/Accessories
C. KITCHEN
Articles No.
Items		 Replacement
Cost
Step Stool
Dinette Set
Electric Appliances
Cabinets/Tables
Kitchen Linens & Curtains
Dishwasher
Oven/Range
Microwave
Dishes
Utensils/Cutlery
Pots & Pans
Bowls, Trays, Etc.
Refrigerator/Freezer
Trash/Garbage Cans
D. CHINA & GLASSWARE
Articles No.
Items		 Replacement
Cost
E. SILVER
Articles No.
Items		 Replacement
Cost
F. LINENS/CLOTHING
Articles No.
Items		 Replacement
Cost
Coats(s)/Jacket(s)
Suit(s)
Dresses
Sport Coats(s)
Slack(s)
Sweater(s)
Blouses(s)
Skirts(s)
Shirt(s)
Sleepwear
Shoes/Boots
Purses/Belts
Hosiery/Socks
Ties/Scarvers
Underwear
Lingerie
Sportswear
Sheet(s)/Pillow Cases
Blanket(s)
Quilts
Other:
G. BASEMENT & GARAGE (excluding car)
Articles No.
Items		 Replacement
Cost
Workbench
Tools
Lawn Mower
Garden Tools
Furniture (Patio)
Luggage/Trunks/Brief Cases
Washing Machine/Dryer
Iron/Ironing Board
Vacuum
Other:
H. BATHROOMS
Articles No.
Items		 Replacement
Cost
Rugs Toilet Covers
Toilet Articles/Medical Supp.
Towels, Etc.
Clothes Hamper
Trash Can
Cabinets/Shelves/Mirrors
Razors, Hair Dryers
Misc.
Column Sub-Total
I. BEDROOM NO. 1 (Master)
Articles No.
Items		 Replacement
Cost
Bed(s)
Chair(s)
Night Table(s)
Dress Table/Vanity
Chest & Drawers
Mirror(s)
Rug(s)
Lamp(s)
Curtains & Drapes
Bookcase(s)
Desk(s)
Armoire/Wardrobe
Other:
J. BEDROOM NO. 2
Articles No.
Items		 Replacement
Cost
Bed(s)
Chair(s)
Night Table(s)
Dress Table/Vanity
Chest & Drawers
Mirror(s)
Rug(s)
Lamp(s)
Curtains & Drapes
Bookcase(s)
Desk(s)
Armoire/Wardrobe
Other:
K. BEDROOM NO. 3
Articles No.
Items		 Replacement
Cost
Bed(s)
Chair(s)
Night Table(s)
Dress Table/Vanity
Chest & Drawers
Mirror(s)
Rug(s)
Lamp(s)
Curtains & Drapes
Bookcase(s)
Desk(s)
Armoire/Wardrobe
Other:
L. DEN/FAMILY ROOM
Articles No.
Items		 Replacement
Cost
Chair(s)
Curtains & Drapes
Sofa
Table(s)
Lamp(s)
Rug(s) & Carpeting
Desk(s)
Bookcase(s)
Other:
M. MISCELLANEOUS
Articles No.
Items		 Replacement
Cost
Typewriter(s)
Clocks
Bric-a-brac
Baskets, Plant Holders
Toys & Games
Fax/Phone
Liquor/Wine/Food
Computer/Printer
Computer Supplies
Sewing Machine
Sewing Supplies
Sports Equipment
Cameras/Lens
Misc. Camera Equip.
Projectors/Camcorder
Books/Records/Tapes/Film
Pictures/Paintings
Fireplace Equipment
Bicycles
N. OTHER
Articles No.
Items		 Replacement
Cost
Column Sub-Total
TOTAL HOUSEHOLD GOODS

US $
AUTOMOBILE
Yr./Make:
Serial No:

Non-Factory installed auto accessories must be separately listed and valued
TOTAL AUTOMOBILE

US $
GRAND TOTAL - INSURED VALUE

US $
I understant that my shipment is insured for US $ which represents the replacement cost at destination. I further understand that the insured value of the shipment cannot be less than $6.00 per pound and all items over $100.00 in value must be individually declared / itemized.

       




Mailing Address: P.O. Box 284, 15476 NW 76 Ct - Miami Lakes, FL 33016
Tel: (305) 556-1488  Fax: (305) 556-3680