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I declare that the details herein are correct according I A the best of myCover· Destination) ONLY) that the particulars and statements given shall form the
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basis of the and acceptance of the proposal. If in any to
assessment
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doubt as to whether a fact isand belief then it should be disclosed here.
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I copy of under inventoryunless specially declared. insurer
declared the completed proposalitem 33. of letters) of by information on requestto within insure~ for the purpose of enteringtheinto the contract.
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negotiableto instruments pleasegiven in respect inventory notes, shares, three
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You should keepcover will not becopies be supplied all of: bank on the facing page. months of completion of stamps, securities and
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Please note be record (including form complete the the
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Property a insured: supplied the bonds, deeds, jewellery, proposal.
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an Insurer in the
Agency I (Block I -,
BLOCK LETTERSLetters) GIVE A DEFINITEI I ANSWER TO EACH QUESTION
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Inventory of Personal and/or Household Effects
(fhis Inventory will form part of the Policy when issued)
All property should be insured at its full replacement value at destination. Failure to do so will result in
claims being reduced proportionally. Any antique articles must be separately declared and valued under
Item 34 and are subject to special rates to be agreed.
PLEASE NOTE THAT COVER IS SUBJECT TO AN EXCESS OF 1% OF THE TOTAL SUM, INSURED WITH A MINIMUM OF £SO/MAXIMUM 1:250
Description of Effects Sum Insured £: Description of Effects Sum Insured £:
1 Soft Goods (Curtains, Bedding, etc.) . 22 Miscellaneous non-fragile Kitchenware .
2 Clothing (excluding Furs) . 23 Vacuum Cleaner/Floor Polisher .
3 Furs . 24 Sewing Machine .
4 Carpets . 25 Typewriter .
5 Silverware. cutlery and similar. (Articles over 26 Glass. China, Marble. Earthenware etc.
£100 to be separately declared and valued)
27 Piano and/or Organ .
28 Other Musical Instruments .
29 Furniture: Lounge .
6 Television Set .
Dining Room .
7 Video Recorder .
Bedroom .
8 Record Player/Hi-Fi Equipment .
Kitchen .
9 Tape or Cassette Recorder .
30 Other Furniture .
10 Radios .
31 Lawnmower .
11 Cameras .
32 Garden Tools .
12 Other Photographic Equipment .
33 Suitcases, Trunks and/or Containers .
13 Computers . (see note opposite)
14 Washing Machine . 34 Antiques (Give details and separate value for
each item)
15 Spin Dryer .
16 Tumble Dryer .
17 Dish Washer . 35 Any Other Goods (Give details) .
18 Oven and Hob .
19 Microwave Oven .
20 Refrigerator/Deep Freezer .
21 Food Processor/Food Mixer . TOTAL SUM INSURED £: