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					                               Name:
          Uplift address 1 & phone:
          Uplift address 2 & phone:
                      Dwelling type:                    Floor:
                             Parking:
                   Distance of carry:            m      Steps:     Ferry ute?:
                          Obstacles:                               Over balcony?:
       Delivery address 1 & phone:
       Delivery address 2 & phone:
                      Dwelling type:                    Floor:
                             Parking:
                   Distance of carry:            m      Steps:     Ferry ute?:
                          Obstacles:                               Over balcony?:
    Anything else we should know?
                       Date of uplift:
                    Date of delivery:
                      email address:
           Base to pick up address:               km              0 m³
      Distance between addresses:                 km
          Delivery address to base:               km
                      Total distance:           0 km
                        Referred by:
                                          men trucks travel        qty/hrs               ea         Total
Removal Charges - hourly                                                                   $50.00      $0.00
                            by volume                                    0               $110.00       $0.00
book box                                 new                             0                  $4.40      $0.00
                                         used                            0                  $3.00      $0.00
standard box                             new                             0                  $5.50      $0.00
                                         used                            0                  $4.00      $0.00
port-a-robe                              new                             0                 $16.50      $0.00
                                         used                            0                 $14.00      $0.00
                                         loan                            0                 $10.00      $0.00
half wad of packing paper                                                0                 $22.50      $0.00
tape                                                                     0                  $4.40      $0.00
                                         men      hours travel     hr/day           sub-total          $0.00
prepack                                         1      0      0          0                 $50.00      $0.00
unpack                                          1      0      0          0                 $50.00      $0.00
                                                                     qty            sub-total          $0.00
piano                                                                                    $150.00       $0.00
step                                                                                        $5.00      $0.00
                                                                                    sub-total          $0.00
storage                                                                  0                  $3.30      $0.00

Total for move                                                                                         $0.00
Notes/disclaimers
                                              Lounge
                 Item           h(cm)   w(cm) d(cm)    vol    qty   total   value ea   total
> Carton - small                   35      45     35   0.06          0.00                      $0
> Carton - standard                65      45     45   0.13          0.00                      $0
Bookcase                          180      90     30   0.49          0.00                      $0
Chair                              80      70     60   0.34          0.00                      $0
China Cabinet                     120     150     40   0.72          0.00                      $0
Cocktail Cabinet                  120      90     40   0.43          0.00                      $0
Coffee Table                       50     100     60   0.30          0.00                      $0
Computer (in std box)              65      45     45   0.13          0.00                      $0
Entertainment Unit                150      40     60   0.36          0.00                      $0
Heater                             50      70     30   0.11          0.00                      $0
Lamp                              150      30     30   0.14          0.00                      $0
Lounge - 1 seater                  90      90     90   0.73          0.00                      $0
Lounge - 2 seater                  90     140     90   1.13          0.00                      $0
Lounge - 3 Seater                  90     190     90   1.54          0.00                      $0
Magazine tidy                      40      50     30   0.06          0.00                      $0
Moblie air con.                    70      40     40   0.11          0.00                      $0
Ottoman                            40      80     80   0.26          0.00                      $0
Piano - upright                   150     140     50   1.05          0.00                      $0
Piano Stool                        50      50     40   0.10          0.00                      $0
Picture/mirror                    110      80     10   0.09          0.00                      $0
Picture/mirror                     90      70     10   0.06          0.00                      $0
Rocking horse                     120     180     40   0.86          0.00                      $0
Rug (rolled)                      240      30     30   0.22          0.00                      $0
Table                              70     180     90   1.13          0.00                      $0
TV - CRT 26"                       70     100     50   0.35          0.00                      $0
TV - LCD/Plasma 106cm              80     110     10   0.09          0.00                      $0
TV Cabinet                        150      90     60   0.81          0.00                      $0
Vase                              100      40     40   0.16          0.00                      $0




                        Total                                        0.00                      $0
                                              Hall
                 Item           h(cm) w(cm)   d(cm)   vol    qty   total   value ea   total
> Carton - small                   35    45      35   0.06          0.00                      $0
> Carton - standard                65    45      45   0.13          0.00                      $0
Bookcase                          180    90      30   0.49          0.00                      $0
Chair                              80    70      60   0.34          0.00                      $0
Chest Drawers                      90   120      40   0.43          0.00                      $0
Coat Stand                        150    30      30   0.14          0.00                      $0
Dropside Table                     70    70      30   0.15          0.00                      $0
Grandfather Clock                 150    30      30   0.14          0.00                      $0
Hall Stand                        180    90      30   0.49          0.00                      $0
Hall Table                         70    90      30   0.19          0.00                      $0
Pedestal                           70    30      30   0.06          0.00                      $0
Phone Table                        70    60      30   0.13          0.00                      $0
Picture/mirror                    180   100      20   0.36          0.00                      $0
Picture/mirror                     60    60      10   0.04          0.00                      $0
Picture/mirror                    100    80      20   0.16          0.00                      $0
Picture/mirror                     50    40      10   0.02          0.00                      $0
Picture/mirror                     60    40      10   0.02          0.00                      $0
Vase                              100    40      40   0.16          0.00                      $0



                        Total                                       0.00                      $0
                                           Dining Room
                 Item           h(cm)   w(cm) d(cm) vol      qty   total   value ea   total
> Carton - small                   35      45     35 0.06           0.00                      $0
> Carton - standard                65      45     45 0.13           0.00                      $0
Bookcase                          180      90     30 0.49           0.00                      $0
Buffet/Sideboard                  100     170     50 0.85           0.00                      $0
Chair - dining                     90      40     40 0.14           0.00                      $0
Chair -Other                       80      70     60 0.34           0.00                      $0
Crystal Cabinet                   180     300     30 1.62           0.00                      $0
Picture/mirror                    110      80     10 0.09           0.00                      $0
Picture/mirror                     70      90     10 0.06           0.00                      $0
Rug (rolled)                      240      30     30 0.22           0.00                      $0
Table                              70      90    150 0.95           0.00                      $0
Trolley                            70      90     40 0.25           0.00                      $0
TV - LCD/Plasma 106cm              80     110     10 0.09           0.00                      $0
Vase                              100      40     40 0.16           0.00                      $0




                        Total                                       0.00                      $0
                                              Bedroom 1
                  Item            h(cm)   w(cm) d(cm)     vol    qty   total   value ea   total
> Carton - small                     35      45     35    0.06          0.00                      $0
> Carton - standard                  65      45     45    0.13          0.00                      $0
> Portable Robe                     110      50     60    0.33          0.00                      $0
Bed - Double - Base                 200     140     40    1.12          0.00                      $0
Bed - Double - Frame                200     140     10    0.28          0.00                      $0
Bed - Double - Head                  70     140     20    0.20          0.00                      $0
Bed - Double - Mattress             200     140     30    0.84          0.00                      $0
Bed - King - Base                   200     180     40    1.44          0.00                      $0
Bed - King - Frame                  200     180     10    0.36          0.00                      $0
Bed - King - Head                    70     180     20    0.25          0.00                      $0
Bed - King - Mattress               200     180     30    1.08          0.00                      $0
Bed - Queen - Base                  200     150     40    1.20          0.00                      $0
Bed - Queen - Frame                 200     150     10    0.30          0.00                      $0
Bed - Queen - Head                   70     150     20    0.21          0.00                      $0
Bed - Queen - Mattress              200     150     30    0.90          0.00                      $0
Bed - Single - Base                 200     100     40    0.80          0.00                      $0
Bed - Single - Frame                200     100     10    0.20          0.00                      $0
Bed - Single - Head                  70     100     20    0.14          0.00                      $0
Bed - Single - Mattress             200     100     30    0.60          0.00                      $0
Bedside Table/Drawers                70      60     60    0.25          0.00                      $0
Bookcase                            180      90     30    0.49          0.00                      $0
Chair                                80      70     60    0.34          0.00                      $0
Chest                                50      90     40    0.18          0.00                      $0
Chest Drawers                       120      90     40    0.43          0.00                      $0
Cheval Mirror                       150      40     20    0.12          0.00                      $0
Computer (in std box)                65      45     45    0.13          0.00                      $0
Cot                                 120     150     90    1.62          0.00                      $0
Desk                                 70     150     80    0.84          0.00                      $0
Dressing Table                       70      90     40    0.25          0.00                      $0
Dressing Table Stool                 50      50     40    0.10          0.00                      $0
Picture/mirror                       60      80     10    0.05          0.00                      $0
Sofa                                 90     140     90    1.13          0.00                      $0
Suitcase                             50      70     30    0.11          0.00                      $0
TV - LCD/Plasma 106cm                80     110     10    0.09          0.00                      $0
Wardrobe                            210     120     60    1.51          0.00                      $0

Ensuite
> Carton - small                     35      45    35     0.06          0.00                      $0
> Carton - standard                  65      45    45     0.13          0.00                      $0

Walk-in-robe
> Carton - small                     35      45    35     0.06          0.00                      $0
> Carton - standard                  65      45    45     0.13          0.00                      $0
> Portable Robe                     110      50    60     0.33          0.00                      $0
Suitcase                             50      70    30     0.11          0.00                      $0

                          Total                                         0.00                      $0
                                              Bedroom 2
                  Item            h(cm)   w(cm) d(cm)     vol    qty   total   value ea   total
> Carton - small                     35      45     35    0.06          0.00                      $0
> Carton - standard                  65      45     45    0.13          0.00                      $0
> Portable Robe                     110      50     60    0.33          0.00                      $0
Bed - Double - Base                 200     140     40    1.12          0.00                      $0
Bed - Double - Frame                200     140     10    0.28          0.00                      $0
Bed - Double - Head                  70     140     20    0.20          0.00                      $0
Bed - Double - Mattress             200     140     30    0.84          0.00                      $0
Bed - King - Base                   200     180     40    1.44          0.00                      $0
Bed - King - Frame                  200     180     10    0.36          0.00                      $0
Bed - King - Head                    70     180     20    0.25          0.00                      $0
Bed - King - Mattress               200     180     30    1.08          0.00                      $0
Bed - Queen - Base                  200     150     40    1.20          0.00                      $0
Bed - Queen - Frame                 200     150     10    0.30          0.00                      $0
Bed - Queen - Head                   70     150     20    0.21          0.00                      $0
Bed - Queen - Mattress              200     150     30    0.90          0.00                      $0
Bed - Single - Base                 200     100     40    0.80          0.00                      $0
Bed - Single - Frame                200     100     10    0.20          0.00                      $0
Bed - Single - Head                  70     100     20    0.14          0.00                      $0
Bed - Single - Mattress             200     100     30    0.60          0.00                      $0
Bedside Table/Drawers                70      60     60    0.25          0.00                      $0
Bookcase                            180      90     30    0.49          0.00                      $0
Chair                                80      70     60    0.34          0.00                      $0
Chest                                50      90     40    0.18          0.00                      $0
Chest Drawers                       120      90     40    0.43          0.00                      $0
Cheval Mirror                       150      40     20    0.12          0.00                      $0
Computer (in std box)                65      45     45    0.13          0.00                      $0
Cot                                 120     150     90    1.62          0.00                      $0
Desk                                 70     150     80    0.84          0.00                      $0
Dressing Table                       70      90     40    0.25          0.00                      $0
Dressing Table Stool                 50      50     40    0.10          0.00                      $0
Picture/mirror                       60      80     10    0.05          0.00                      $0
Sofa                                 90     140     90    1.13          0.00                      $0
Suitcase                             50      70     30    0.11          0.00                      $0
TV - LCD/Plasma 106cm                80     110     10    0.09          0.00                      $0
Wardrobe                            210     120     60    1.51          0.00                      $0




                          Total                                         0.00                      $0
                                              Bedroom 3
                  Item            h(cm)   w(cm) d(cm)     vol    qty   total   value ea   total
> Carton - small                     35      45     35    0.06          0.00                      $0
> Carton - standard                  65      45     45    0.13          0.00                      $0
> Portable Robe                     110      50     60    0.33          0.00                      $0
Bed - Double - Base                 200     140     40    1.12          0.00                      $0
Bed - Double - Frame                200     140     10    0.28          0.00                      $0
Bed - Double - Head                  70     140     20    0.20          0.00                      $0
Bed - Double - Mattress             200     140     30    0.84          0.00                      $0
Bed - King - Base                   200     180     40    1.44          0.00                      $0
Bed - King - Frame                  200     180     10    0.36          0.00                      $0
Bed - King - Head                    70     180     20    0.25          0.00                      $0
Bed - King - Mattress               200     180     30    1.08          0.00                      $0
Bed - Queen - Base                  200     150     40    1.20          0.00                      $0
Bed - Queen - Frame                 200     150     10    0.30          0.00                      $0
Bed - Queen - Head                   70     150     20    0.21          0.00                      $0
Bed - Queen - Mattress              200     150     30    0.90          0.00                      $0
Bed - Single - Base                 200     100     40    0.80          0.00                      $0
Bed - Single - Frame                200     100     10    0.20          0.00                      $0
Bed - Single - Head                 100     100    200    2.00          0.00                      $0
Bed - Single - Mattress             200     100     30    0.60          0.00                      $0
Bedside Table/Drawers                70      60     60    0.25          0.00                      $0
Bookcase                            180      90     30    0.49          0.00                      $0
Chair                                80      70     60    0.34          0.00                      $0
Chest                                50      90     40    0.18          0.00                      $0
Chest Drawers                       120      90     40    0.43          0.00                      $0
Cheval Mirror                       150      40     20    0.12          0.00                      $0
Computer (in std box)                65      45     45    0.13          0.00                      $0
Cot                                 120     150     90    1.62          0.00                      $0
Desk                                 70     150     80    0.84          0.00                      $0
Dressing Table                       70      90     40    0.25          0.00                      $0
Dressing Table Stool                 50      50     40    0.10          0.00                      $0
Picture/mirror                       60      80     10    0.05          0.00                      $0
Sofa                                 90     140     90    1.13          0.00                      $0
Suitcase                             50      70     30    0.11          0.00                      $0
TV - LCD/Plasma 106cm                80     110     10    0.09          0.00                      $0
Wardrobe                            210     120     60    1.51          0.00                      $0




                          Total                                         0.00                      $0
                                           Bedroom 4 & Guest
                Item              h(cm)   w(cm) d(cm) vol      qty   total   value ea   total
> Carton - small                     35      45    35 0.06            0.00                      $0
> Carton - standard                  65      45    45 0.13            0.00                      $0
> Portable Robe                     110      50    60 0.33            0.00                      $0
Bed - Double - Base                 200     140    40 1.12            0.00                      $0
Bed - Double - Frame                200     140    10 0.28            0.00                      $0
Bed - Double - Head                  70     140    20 0.20            0.00                      $0
Bed - Double - Mattress             200     140    30 0.84            0.00                      $0
Bed - King - Base                   200     180    40 1.44            0.00                      $0
Bed - King - Frame                  200     180    10 0.36            0.00                      $0
Bed - King - Head                    70     180    20 0.25            0.00                      $0
Bed - King - Mattress               200     180    30 1.08            0.00                      $0
Bed - Queen - Base                  200     150    40 1.20            0.00                      $0
Bed - Queen - Frame                 200     150    10 0.30            0.00                      $0
Bed - Queen - Head                   70     150    20 0.21            0.00                      $0
Bed - Queen - Mattress              200     150    30 0.90            0.00                      $0
Bed - Single - Base                 200     100    40 0.80            0.00                      $0
Bed - Single - Frame                200     100    10 0.20            0.00                      $0
Bed - Single - Head                  70     100    20 0.14            0.00                      $0
Bed - Single - Mattress             200     100    30 0.60            0.00                      $0
Bedside Table/Drawers                70      60    60 0.25            0.00                      $0
Bookcase                            180      90    30 0.49            0.00                      $0
Chair                                80      70    60 0.34            0.00                      $0
Chest                                50      90    40 0.18            0.00                      $0
Chest Drawers                       120      90    40 0.43            0.00                      $0
Cheval Mirror                       150      40    20 0.12            0.00                      $0
Computer (in std box)                65      45    45 0.13            0.00                      $0
Cot                                 120     150    90 1.62            0.00                      $0
Desk                                 70     150    80 0.84            0.00                      $0
Dressing Table                       70      90    40 0.25            0.00                      $0
Dressing Table Stool                 50      50    40 0.10            0.00                      $0
Picture/mirror                       60      80    10 0.05            0.00                      $0
Sofa                                 90     140    90 1.13            0.00                      $0
Suitcase                             50      70    30 0.11            0.00                      $0
TV - LCD/Plasma 106cm                80     110    10 0.09            0.00                      $0
Wardrobe                            210     120    60 1.51            0.00                      $0




                          Total                                       0.00                      $0
                                              Sun Room/Office
                Item                h(cm)   w(cm) d(cm) vol      qty   total   value ea   total
> Carton - small                       35      45    35 0.06            0.00                      $0
> Carton - standard                    65      45    45 0.13            0.00                      $0
> Portable Robe                       110      50    60 0.33            0.00                      $0
Bed - Double - Base                   200     140    40 1.12            0.00                      $0
Bed - Double - Frame                  200     140    10 0.28            0.00                      $0
Bed - Double - Head                    70     140    20 0.20            0.00                      $0
Bed - Double - Mattress               200     140    30 0.84            0.00                      $0
Bed - King - Base                     200     180    40 1.44            0.00                      $0
Bed - King - Frame                    200     180    10 0.36            0.00                      $0
Bed - King - Head                      70     180    20 0.25            0.00                      $0
Bed - King - Mattress                 200     180    30 1.08            0.00                      $0
Bed - Queen - Base                    200     150    40 1.20            0.00                      $0
Bed - Queen - Frame                   200     150    10 0.30            0.00                      $0
Bed - Queen - Head                     70     150    20 0.21            0.00                      $0
Bed - Queen - Mattress                200     150    30 0.90            0.00                      $0
Bed - Single - Base                   200     100    40 0.80            0.00                      $0
Bed - Single - Frame                  200     100    10 0.20            0.00                      $0
Bed - Single - Head                    70     100    20 0.14            0.00                      $0
Bed - Single - Mattress               200     100    30 0.60            0.00                      $0
Bedside Table/Drawers                  70      60    60 0.25            0.00                      $0
Bookcase                              180      90    30 0.49            0.00                      $0
Chair                                  80      70    60 0.34            0.00                      $0
Chest                                  50      90    40 0.18            0.00                      $0
Chest Drawers                         120      90    40 0.43            0.00                      $0
Cheval Mirror                         150      40    20 0.12            0.00                      $0
Computer (in std box)                  65      45    45 0.13            0.00                      $0
Cot                                   120     150    90 1.62            0.00                      $0
Desk                                   70     150    80 0.84            0.00                      $0
Dressing Table                         70      90    40 0.25            0.00                      $0
Dressing Table Stool                   50      50    40 0.10            0.00                      $0
Picture/mirror                         60      80    10 0.05            0.00                      $0
Sofa                                   90     140    90 1.13            0.00                      $0
Suitcase                               50      70    30 0.11            0.00                      $0
TV - LCD/Plasma 106cm                  80     110    10 0.09            0.00                      $0
Wardrobe                              210     120    60 1.51            0.00                      $0

Office
> Carton - small                       35      45    35   0.06          0.00                      $0
> Carton - standard                    65      45    45   0.13          0.00                      $0
Bookcase                              180      90    30   0.49          0.00                      $0
Desk                                   70     150    80   0.84          0.00                      $0
Filing Cabinet - 4 drawer             120      60    80   0.58          0.00                      $0




                            Total                                       0.00                      $0
                                            Laundry
               Item           h(cm) w(cm)   d(cm)     vol    qty   total   value ea   total
> Carton - small                 35    45      35     0.06          0.00                      $0
> Carton - standard              65    45      45     0.13          0.00                      $0
Airer                            15   120      20     0.04          0.00                      $0
Brooms etc (bundle)             150    30      30     0.14          0.00                      $0
Cupboard                         70   120      40     0.34          0.00                      $0
Dryer                            80    65      65     0.34          0.00                      $0
Ironing Board                   120    35      10     0.04          0.00                      $0
Laundry Basket                   30    50      40     0.06          0.00                      $0
Laundry Trolley                  70    50      40     0.14          0.00                      $0
Stool                            70    30      30     0.06          0.00                      $0
Table                            70   150      90     0.95          0.00                      $0
Vacuum Cleaner                  120    45      45     0.24          0.00                      $0
Washing Machine                 110    70      70     0.54          0.00                      $0




                      Total                                         0.00                      $0
                                        Bathroom 1
               Item           h(cm) w(cm) d(cm) vol          qty   total   value ea   total
> Carton - small                 35    45    35 0.06                0.00                      $0
> Carton - standard              65    45    45 0.13                0.00                      $0




                      Total                                         0.00                      $0
                                                Sundries
                 Item              h(cm)   w(cm) d(cm) vol     qty   total   value ea   total
> Carton - small                      35      45     35 0.06          0.00                      $0
> Carton - standard                   65      45     45 0.13          0.00                      $0
Car Seat                              80      40     40 0.13          0.00                      $0
Child's Chair                         50      30     30 0.05          0.00                      $0
Computer                              65      45     45 0.13          0.00                      $0
Doll's House                         100      60     40 0.24          0.00                      $0
Golf Bags                            100      40     50 0.20          0.00                      $0
Golf Buggy - collapsed               100      30     30 0.09          0.00                      $0
Heater                                50      70     30 0.11          0.00                      $0
Plastic Crates                        50      50     80 0.20          0.00                      $0
Portable Air Conditioner              70      40     40 0.11          0.00                      $0
Pram - collapsed                     120      80     30 0.29          0.00                      $0
Scooter - collapsed                   80      20     15 0.02          0.00                      $0
Sewing Cabinet                        70      90     40 0.25          0.00                      $0
Skis                                   2      25     25 0.00          0.00                      $0
Suitcases                             50      70     30 0.11          0.00                      $0
Toy Pram                              70      70     30 0.15          0.00                      $0
Trike                                 70      50     80 0.28          0.00                      $0
Trunk                                 50      90     40 0.18          0.00                      $0
Xmas Tree                            180      30     30 0.16          0.00                      $0




                           Total                                      0.00                      $0
                                             Outside Effects
                  Item             h(cm)   w(cm) d(cm) vol     qty   total   value ea   total
> Carton - small                      35      45     35 0.06          0.00                      $0
> Carton - standard                   65      45     45 0.13          0.00                      $0
Basket                                70      40     40 0.11          0.00                      $0
BBQ - 4 burner                       110     140     65 1.00          0.00                      $0
Bicycle                              100      50    150 0.75          0.00                      $0
Bin                                   60      50     50 0.15          0.00                      $0
Blower                                30     100     30 0.09          0.00                      $0
Chair                                 80      70     60 0.34          0.00                      $0
Compost Bin                           40      80     40 0.13          0.00                      $0
Cubby House - collapsed               30     120    120 0.43          0.00                      $0
Cupboard                              70      90     30 0.19          0.00                      $0
Dog Kennel                            70      60     70 0.29          0.00                      $0
Esky                                  40      40     50 0.08          0.00                      $0
Folding Chairs                        20      70    120 0.17          0.00                      $0
Garden Seat                           60      80     40 0.19          0.00                      $0
Garden Tools                         150      40     40 0.24          0.00                      $0
Gym Equipment - cycle                120     100     60 0.72          0.00                      $0
Ladder                               180      60     15 0.16          0.00                      $0
Mower & Catcher                       50      50    120 0.30          0.00                      $0
Pot Plant - large                    200      70     70 0.98          0.00                      $0
Pot Plant - small                     60      30     30 0.05          0.00                      $0
Sand Pit                              20      90     90 0.16          0.00                      $0
Shelving                              30     120     30 0.11          0.00                      $0
Statues                               90      40     40 0.14          0.00                      $0
Surfboard                            180      45     10 0.08          0.00                      $0
Swing - collapsed                     40     240     40 0.38          0.00                      $0
Table                                 70     240    100 1.68          0.00                      $0
Table Tennis - collapsed              10     240    150 0.36          0.00                      $0
Tool Chest                            40      90     40 0.14          0.00                      $0
Trampoline - collapsed                10     240    180 0.43          0.00                      $0
Wheelbarrow                           70     130     60 0.55          0.00                      $0
Whipper Snipper                      150      30     30 0.14          0.00                      $0
Work Bench                            70     120     60 0.50          0.00                      $0
Table                                 70      70     70 0.34          0.00                      $0
Umbrella                             100      30     30 0.09          0.00                      $0




                           Total                                      0.00                      $0
                                           Miscellaneous
                 Item           h(cm)   w(cm) d(cm) vol      qty   total   value ea   total
> Carton - small                   35      45      35 0.06          0.00                      $0
> Carton - standard                65      45      45 0.13          0.00                      $0
Brooms etc (bundle)               150      30      30 0.14          0.00                      $0
Clothing Rack                     150     210      40 1.26          0.00                      $0
Computer                           65      45      45 0.13          0.00                      $0
Market Umbrella                   240      30      30 0.22          0.00                      $0
Ottoman                            50      60      60 0.18          0.00                      $0
Pool Table                         70     180      90 1.13          0.00                      $0
Spin Cycle                        120     100      80 0.96          0.00                      $0
Sports Equipment                   50      30      30 0.05          0.00                      $0
Treadmill                         120     150      80 1.44          0.00                      $0
Umbrella                          100      30      30 0.09          0.00                      $0




                        Total                                       0.00                      $0
                                         Bathroom 2
                 Item           h(cm) w(cm) d(cm) vol        qty   total   value ea   total
> Carton - small                   35    45    35 0.06              0.00                      $0
> Carton - standard                65    45    45 0.13              0.00                      $0




                        Total                                       0.00                      $0
                                           Family Room
                 Item           h(cm)   w(cm) d(cm) vol     qty   total   value ea   total
> Carton - small                   35      45     35 0.06          0.00                      $0
> Carton - standard                65      45     45 0.13          0.00                      $0
Bar                               120     120     30 0.43          0.00                      $0
Bar Fridge                         80      50     60 0.24          0.00                      $0
Bar Stool                         130      30     30 0.12          0.00                      $0
Bookcase                          180      90     30 0.49          0.00                      $0
Bureau                             70     150     80 0.84          0.00                      $0
Chair                              80      70     60 0.34          0.00                      $0
China Cabinet                     180      90     30 0.49          0.00                      $0
Cocktail Cabinet                   70     120     40 0.34          0.00                      $0
Coffee Table                      100     150     60 0.90          0.00                      $0
Desk                               70     150     80 0.84          0.00                      $0
Entertainment Unit                180      90     40 0.65          0.00                      $0
Heater                             50      70     30 0.11          0.00                      $0
Lamp                              100      40     50 0.20          0.00                      $0
Lounge - 1 seater                  90      90     90 0.73          0.00                      $0
Lounge - 2 seater                  90     140     90 1.13          0.00                      $0
Lounge - 3 Seater                  90     190     90 1.54          0.00                      $0
Magazine tidy                      40      50     30 0.06          0.00                      $0
Pedestal Fan                       90      40     40 0.14          0.00                      $0
Piano - upright                   150     140     50 1.05          0.00                      $0
Piano Stool                        50      50     40 0.10          0.00                      $0
Picture/mirror                    110      80     10 0.09          0.00                      $0
Pouffs                             50      60     60 0.18          0.00                      $0
Rug (rolled)                      240      30     30 0.22          0.00                      $0
TV - LCD/Plasma 106cm              80     110     10 0.09          0.00                      $0
Table                              70      90     90 0.57          0.00                      $0




                        Total                                      0.00                      $0
                                                 Kitchen
                 Item              h(cm)   w(cm) d(cm)     vol    qty   total   value ea   total
> Carton - small                      35      45      35   0.06          0.00                      $0
> Carton - standard                   65      45      45   0.13          0.00                      $0
Bar Stool                            130      30      30   0.12          0.00                      $0
Cabinet                               70      90      30   0.19          0.00                      $0
Chair - dining                        90      40      40   0.14          0.00                      $0
Dishwasher                            70      60      60   0.25          0.00                      $0
Freezer                               90      90      70   0.57          0.00                      $0
Fridge                               160     100      75   1.20          0.00                      $0
High Chair                            90      50      60   0.27          0.00                      $0
Microwave                             40      80      50   0.16          0.00                      $0
Table                                 70     180      90   1.13          0.00                      $0
Tidy                                  50      30      30   0.05          0.00                      $0
double door fridge                   180     120      80   1.73          0.00




                           Total                                         0.00                      $0
                                                 Garage
                 Item              h(cm)   w(cm) d(cm)     vol    qty   total   value ea   total
> Carton - small                      35      45     35    0.06          0.00                      $0
> Carton - standard                   65      45     45    0.13          0.00                      $0
Basket                                70      40     40    0.11          0.00                      $0
Bicycle                              100      50    150    0.75          0.00                      $0
Blower                                30     100     30    0.09          0.00                      $0
Chair                                 80      70     60    0.34          0.00                      $0
Cupboard                              70      90     30    0.19          0.00                      $0
Esky                                  40      40     50    0.08          0.00                      $0
Folding Chairs                        20      70    120    0.17          0.00                      $0
Garden Tools                         150      40     40    0.24          0.00                      $0
Gym Equipment - cycle                120     100     60    0.72          0.00                      $0
Ladder                               180      60     15    0.16          0.00                      $0
Mower & Catcher                       50      50    120    0.30          0.00                      $0
Shelving                              30     120     30    0.11          0.00                      $0
Surfboard                            180      45     10    0.08          0.00                      $0
Table Tennis - collapsed              10     240    150    0.36          0.00                      $0
Tool Chest                            40      90     40    0.14          0.00                      $0
Wheelbarrow                           70     130     60    0.55          0.00                      $0
Whipper Snipper                      150      30     30    0.14          0.00                      $0
Work Bench                            70     120     60    0.50          0.00                      $0


                           Total                                         0.00                      $0
                                                Totals
                Room                h(cm) w(cm) d(cm)    vol   qty       total   total
Lounge                                                                    0.00           $0
Hall                                                                      0.00           $0
Dining Room                                                               0.00           $0
Bedroom 1                                                                 0.00           $0
Bedroom 2                                                                 0.00           $0
Bedroom 3                                                                 0.00           $0
Bedroom 4 & Guest                                                         0.00           $0
Sun Room/Office                                                           0.00           $0
Laundry                                                                   0.00           $0
Bathroom 1                                                                0.00           $0
Sundries                                                                  0.00           $0
Outside Effects                                                           0.00           $0
Miscellaneous                                                             0.00           $0
Bathroom 2                                                                0.00           $0
Family Room                                                               0.00           $0
Kitchen                                                                   0.00           $0
Garage                                                                    0.00           $0




                            Total                                         0.00           $0
                                          Packing Materials
                                     Cartons
                Room               book std porta
Lounge                                 0     0
Hall                                   0     0
Dining Room                            0     0
Bedroom 1                              0     0      0
                          Ensuite      0     0
                     Walk-in-robe      0     0      0
Bedroom 2                              0     0      0
Bedroom 3                              0     0      0
Bedroom 4 & Guest                      0     0      0
Sun Room/Office                        0     0      0
                            Office     0     0
Laundry                                0     0
Bathroom 1                             0     0
Sundries                               0     0
Outside Effects                        0     0
Miscellaneous                          0     0
Bathroom 2                             0     0
Family Room                            0     0
Kitchen                                0     0
Garage                                 0     0                 tape paper

                                        0     0      0               0      0
                                                              E.J.SHAW REMOVALS
                                                                         ABN 18 133 976 735
                                                             3 Rowe St, Freshwater, NSW 2096
                                                       Ph: (02) 9938 1452, Fax: (02) 9905 0980
                                                               email: ejshaw2096@gmail.com
                                                        Authorised Representative No. 344535


                                                      INSURANCE DECLARATION

  Select your required cover (X):                      Periods Covered                                 Risks Covered                              Basis of Settlement
                                            Transit                                       Full Cover, OR                                 Market Value, OR
                                            Storage                                       Restricted Cover                               Replacement Cost


Use the inventory on previous pages to itemise the value of your goods. If you prefer, you may simply declare the Total Value of your goods.
If you have selected Replacement Cost cover, ensure that you estimate the cost of new goods of similar type. If you have selected Market Value
Cover, estimate the amount which your goods would be worth.
Remember that if you underestimate the value by more than 20%, the amount of your claim may be reduced.


Lounge                                  $0 Bedroom 3                                  $0 Sundries                                   $0 Kitchen                                    $0
Hall                                    $0 Bedroom 4 & Guest                          $0 Outside Effects                            $0 Garage                                     $0
Dining Room                             $0 Sun Room/Office                            $0 Miscellaneous                              $0
Bedroom 1                               $0 Laundry                                    $0 Bathroom 2                                 $0
Bedroom 2                               $0 Bathroom 1                                 $0 Family Room                                $0

                                                                                                                               Total Declared Value                               $0




Valuables: Please list and estimate the value of any antique, curio, piece of jewellery, plate, precious object, work of art, medal, money, coin,
stamp, collection of items, fur, piece of precision equipment or professionally packed carton by the removal company whose value exceeds $1,000
in the table below. Attach a detailed inventory if you need more space.


Specified Item                                                               Value        Specified Item                                                                 Value




Declaration - I declare that the above values are correct to the best of my knowledge and that I have informed the Removal Company about
anything which could affect the risk. I have received a copy of the FSG and PDS.



   SIGNATURE:                                                                                      DATE:


   PRINT NAME:                                           0




Reshaw Pty Ltd trading as EJ Shaw Removals is an authorised representative of Aldridge & Street a Division of Cowden (VIC) Pty Ltd which holds Australian Financial Services Licence
                                                                                    No 245658
dwelling floor   parking y/n
                 n       yes
duplex basement o resrictions
house ground none        no
terrace        1
townhouse      2
unit           3
         lift
                               Name:
          Uplift address 1 & phone:
          Uplift address 2 & phone:
                      Dwelling type:                    Floor:
                             Parking:
                   Distance of carry:            m      Steps:     Ferry ute?:
                          Obstacles:                               Over balcony?:
       Delivery address 1 & phone:
       Delivery address 2 & phone:
                      Dwelling type:                    Floor:
                             Parking:
                   Distance of carry:            m      Steps:     Ferry ute?:
                          Obstacles:                               Over balcony?:
    Anything else we should know?
                       Date of uplift:
                    Date of delivery:
                      email address:
           Base to pick up address:               km              0 m³
      Distance between addresses:                 km
          Delivery address to base:               km
                      Total distance:           0 km
                        Referred by:
                                          men trucks travel        qty/hrs               ea         Total
Removal Charges - hourly                                                                   $50.00      $0.00
                            by volume                                    0               $110.00       $0.00
book box                                 new                             0                  $4.40      $0.00
                                         used                            0                  $3.00      $0.00
standard box                             new                             0                  $5.50      $0.00
                                         used                            0                  $4.00      $0.00
port-a-robe                              new                             0                 $16.50      $0.00
                                         used                            0                 $14.00      $0.00
                                         loan                            0                 $10.00      $0.00
half wad of packing paper                                                0                 $22.50      $0.00
tape                                                                     0                  $4.40      $0.00
                                         men      hours travel     hr/day           sub-total          $0.00
prepack                                         1      0      0          0                 $50.00      $0.00
unpack                                          1      0      0          0                 $50.00      $0.00
                                                                     qty            sub-total          $0.00
piano                                                                                    $150.00       $0.00
step                                                                                        $5.00      $0.00
                                                                                    sub-total          $0.00
storage                                                                  0                  $3.30      $0.00

Total for move                                                                                         $0.00
Notes/disclaimers
                                    Lounge
              Item      h(cm) w(cm) d(cm)    vol    qty   total   value ea   total
> Carton - small           35    45     35   0.06          0.00                      $0
> Carton - standard        65    45     45   0.13          0.00                      $0
Bookcase                  180    90     30   0.49          0.00                      $0
Chair                      80    70     60   0.34          0.00                      $0
China Cabinet             120   150     40   0.72          0.00                      $0
Cocktail Cabinet          120    90     40   0.43          0.00                      $0
Coffee Table               50   100     60   0.30          0.00                      $0
Computer (in std box)      65    45     45   0.13          0.00                      $0
Entertainment Unit        150    40     60   0.36          0.00                      $0
Heater                     50    70     30   0.11          0.00                      $0
Lamp                      150    30     30   0.14          0.00                      $0
Lounge - 1 seater          90    90     90   0.73          0.00                      $0
Lounge - 2 seater          90   140     90   1.13          0.00                      $0
Lounge - 3 Seater          90   190     90   1.54          0.00                      $0
Magazine tidy              40    50     30   0.06          0.00                      $0
Moblie air con.            70    40     40   0.11          0.00                      $0
Ottoman                    40    80     80   0.26          0.00                      $0
Piano - upright           150   140     50   1.05          0.00                      $0
Piano Stool                50    50     40   0.10          0.00                      $0
Picture/mirror            110    80     10   0.09          0.00                      $0
Picture/mirror             90    70     10   0.06          0.00                      $0
Rocking horse             120   180     40   0.86          0.00                      $0
Rug (rolled)              240    30     30   0.22          0.00                      $0
Table                      70   180     90   1.13          0.00                      $0
TV - CRT 26"               70   100     50   0.35          0.00                      $0
TV - LCD/Plasma 106cm      80   110     10   0.09          0.00                      $0
TV Cabinet                150    90     60   0.81          0.00                      $0
Vase                      100    40     40   0.16          0.00                      $0
                        Total                                      0.00                      $0
                                            Hall
               Item             h(cm) w(cm) d(cm)    vol    qty   total   value ea   total
> Carton - small                   35    45    35    0.06          0.00                      $0
> Carton - standard                65    45    45    0.13          0.00                      $0
Bookcase                          180    90    30    0.49          0.00                      $0
Chair                              80    70    60    0.34          0.00                      $0
Chest Drawers                      90   120    40    0.43          0.00                      $0
Coat Stand                        150    30    30    0.14          0.00                      $0
Dropside Table                     70    70    30    0.15          0.00                      $0
Grandfather Clock                 150    30    30    0.14          0.00                      $0
Hall Stand                        180    90    30    0.49          0.00                      $0
Hall Table                         70    90    30    0.19          0.00                      $0
Pedestal                           70    30    30    0.06          0.00                      $0
Phone Table                        70    60    30    0.13          0.00                      $0
Picture/mirror                    180   100    20    0.36          0.00                      $0
Picture/mirror                     60    60    10    0.04          0.00                      $0
Picture/mirror                    100    80    20    0.16          0.00                      $0
Picture/mirror                     50    40    10    0.02          0.00                      $0
Picture/mirror                     60    40    10    0.02          0.00                      $0
Vase                              100    40    40    0.16          0.00                      $0




                        Total                                      0.00                      $0
                                           Dining Room
               Item             h(cm)   w(cm) d(cm) vol     qty   total   value ea   total
> Carton - small                   35      45     35 0.06          0.00                      $0
> Carton - standard                65      45     45 0.13          0.00                      $0
Bookcase                          180      90     30 0.49          0.00                      $0
Buffet/Sideboard                  100     170     50 0.85          0.00                      $0
Chair - dining                     90      40     40 0.14          0.00                      $0
Chair -Other                       80      70     60 0.34          0.00                      $0
Crystal Cabinet                   180     300     30 1.62          0.00                      $0
Picture/mirror                    110      80     10 0.09          0.00                      $0
Picture/mirror                     70      90     10 0.06          0.00                      $0
Rug (rolled)                      240      30     30 0.22          0.00                      $0
Table                              70      90    150 0.95          0.00                      $0
Trolley                            70      90     40 0.25          0.00                      $0
TV - LCD/Plasma 106cm              80     110     10 0.09          0.00                      $0
Vase                              100      40     40 0.16          0.00                      $0
Total   0.00   $0
                                            Bedroom 1
               Item               h(cm) w(cm) d(cm)     vol    qty   total   value ea   total
> Carton - small                     35    45     35    0.06          0.00                      $0
> Carton - standard                  65    45     45    0.13          0.00                      $0
> Portable Robe                     110    50     60    0.33          0.00                      $0
Bed - Double - Base                 200   140     40    1.12          0.00                      $0
Bed - Double - Frame                200   140     10    0.28          0.00                      $0
Bed - Double - Head                  70   140     20    0.20          0.00                      $0
Bed - Double - Mattress             200   140     30    0.84          0.00                      $0
Bed - King - Base                   200   180     40    1.44          0.00                      $0
Bed - King - Frame                  200   180     10    0.36          0.00                      $0
Bed - King - Head                    70   180     20    0.25          0.00                      $0
Bed - King - Mattress               200   180     30    1.08          0.00                      $0
Bed - Queen - Base                  200   150     40    1.20          0.00                      $0
Bed - Queen - Frame                 200   150     10    0.30          0.00                      $0
Bed - Queen - Head                   70   150     20    0.21          0.00                      $0
Bed - Queen - Mattress              200   150     30    0.90          0.00                      $0
Bed - Single - Base                 200   100     40    0.80          0.00                      $0
Bed - Single - Frame                200   100     10    0.20          0.00                      $0
Bed - Single - Head                  70   100     20    0.14          0.00                      $0
Bed - Single - Mattress             200   100     30    0.60          0.00                      $0
Bedside Table/Drawers                70    60     60    0.25          0.00                      $0
Bookcase                            180    90     30    0.49          0.00                      $0
Chair                                80    70     60    0.34          0.00                      $0
Chest                                50    90     40    0.18          0.00                      $0
Chest Drawers                       120    90     40    0.43          0.00                      $0
Cheval Mirror                       150    40     20    0.12          0.00                      $0
Computer (in std box)                65    45     45    0.13          0.00                      $0
Cot                                 120   150     90    1.62          0.00                      $0
Desk                                 70   150     80    0.84          0.00                      $0
Dressing Table                       70    90     40    0.25          0.00                      $0
Dressing Table Stool                 50    50     40    0.10          0.00                      $0
Picture/mirror                       60    80     10    0.05          0.00                      $0
Sofa                                 90   140     90    1.13          0.00                      $0
Suitcase                             50    70     30    0.11          0.00                      $0
TV - LCD/Plasma 106cm                80   110     10    0.09          0.00                      $0
Wardrobe                            210   120     60    1.51          0.00                      $0

Ensuite
> Carton - small                     35    45    35     0.06          0.00                      $0
> Carton - standard                  65    45    45     0.13          0.00                      $0

Walk-in-robe
> Carton - small                     35    45    35     0.06          0.00                      $0
> Carton - standard                  65    45    45     0.13          0.00                      $0
> Portable Robe                     110    50    60     0.33          0.00                      $0
Suitcase                             50    70    30     0.11          0.00                      $0

                          Total                                       0.00                      $0
                                    Bedroom 2
               Item       h(cm) w(cm) d(cm)     vol    qty   total   value ea   total
> Carton - small             35    45     35    0.06          0.00                      $0
> Carton - standard          65    45     45    0.13          0.00                      $0
> Portable Robe             110    50     60    0.33          0.00                      $0
Bed - Double - Base         200   140     40    1.12          0.00                      $0
Bed - Double - Frame        200   140     10    0.28          0.00                      $0
Bed - Double - Head          70   140     20    0.20          0.00                      $0
Bed - Double - Mattress     200   140     30    0.84          0.00                      $0
Bed - King - Base           200   180     40    1.44          0.00                      $0
Bed - King - Frame          200   180     10    0.36          0.00                      $0
Bed - King - Head            70   180     20    0.25          0.00                      $0
Bed - King - Mattress       200   180     30    1.08          0.00                      $0
Bed - Queen - Base          200   150     40    1.20          0.00                      $0
Bed - Queen - Frame         200   150     10    0.30          0.00                      $0
Bed - Queen - Head           70   150     20    0.21          0.00                      $0
Bed - Queen - Mattress      200   150     30    0.90          0.00                      $0
Bed - Single - Base         200   100     40    0.80          0.00                      $0
Bed - Single - Frame        200   100     10    0.20          0.00                      $0
Bed - Single - Head          70   100     20    0.14          0.00                      $0
Bed - Single - Mattress     200   100     30    0.60          0.00                      $0
Bedside Table/Drawers        70    60     60    0.25          0.00                      $0
Bookcase                    180    90     30    0.49          0.00                      $0
Chair                        80    70     60    0.34          0.00                      $0
Chest                        50    90     40    0.18          0.00                      $0
Chest Drawers               120    90     40    0.43          0.00                      $0
Cheval Mirror               150    40     20    0.12          0.00                      $0
Computer (in std box)        65    45     45    0.13          0.00                      $0
Cot                         120   150     90    1.62          0.00                      $0
Desk                         70   150     80    0.84          0.00                      $0
Dressing Table               70    90     40    0.25          0.00                      $0
Dressing Table Stool         50    50     40    0.10          0.00                      $0
Picture/mirror               60    80     10    0.05          0.00                      $0
Sofa                         90   140     90    1.13          0.00                      $0
Suitcase                     50    70     30    0.11          0.00                      $0
TV - LCD/Plasma 106cm        80   110     10    0.09          0.00                      $0
Wardrobe                    210   120     60    1.51          0.00                      $0
                          Total                                       0.00                      $0
                                            Bedroom 3
               Item               h(cm) w(cm) d(cm)     vol    qty   total   value ea   total
> Carton - small                     35    45     35    0.06          0.00                      $0
> Carton - standard                  65    45     45    0.13          0.00                      $0
> Portable Robe                     110    50     60    0.33          0.00                      $0
Bed - Double - Base                 200   140     40    1.12          0.00                      $0
Bed - Double - Frame                200   140     10    0.28          0.00                      $0
Bed - Double - Head                  70   140     20    0.20          0.00                      $0
Bed - Double - Mattress             200   140     30    0.84          0.00                      $0
Bed - King - Base                   200   180     40    1.44          0.00                      $0
Bed - King - Frame                  200   180     10    0.36          0.00                      $0
Bed - King - Head                    70   180     20    0.25          0.00                      $0
Bed - King - Mattress               200   180     30    1.08          0.00                      $0
Bed - Queen - Base                  200   150     40    1.20          0.00                      $0
Bed - Queen - Frame                 200   150     10    0.30          0.00                      $0
Bed - Queen - Head                   70   150     20    0.21          0.00                      $0
Bed - Queen - Mattress              200   150     30    0.90          0.00                      $0
Bed - Single - Base                 200   100     40    0.80          0.00                      $0
Bed - Single - Frame                200   100     10    0.20          0.00                      $0
Bed - Single - Head                 100   100    200    2.00          0.00                      $0
Bed - Single - Mattress             200   100     30    0.60          0.00                      $0
Bedside Table/Drawers                70    60     60    0.25          0.00                      $0
Bookcase                            180    90     30    0.49          0.00                      $0
Chair                                80    70     60    0.34          0.00                      $0
Chest                                50    90     40    0.18          0.00                      $0
Chest Drawers                       120    90     40    0.43          0.00                      $0
Cheval Mirror                       150    40     20    0.12          0.00                      $0
Computer (in std box)                65    45     45    0.13          0.00                      $0
Cot                                 120   150     90    1.62          0.00                      $0
Desk                                 70   150     80    0.84          0.00                      $0
Dressing Table                       70    90     40    0.25          0.00                      $0
Dressing Table Stool                 50    50     40    0.10          0.00                      $0
Picture/mirror                       60    80     10    0.05          0.00                      $0
Sofa                                 90   140     90    1.13          0.00                      $0
Suitcase                             50    70     30    0.11          0.00                      $0
TV - LCD/Plasma 106cm                80   110     10    0.09          0.00                      $0
Wardrobe                            210   120     60    1.51          0.00                      $0
Total   0.00   $0
                                         Bedroom 4 & Guest
                 Item             h(cm) w(cm) d(cm) vol      qty   total   value ea   total
> Carton - small                     35    45    35 0.06            0.00                      $0
> Carton - standard                  65    45    45 0.13            0.00                      $0
> Portable Robe                     110    50    60 0.33            0.00                      $0
Bed - Double - Base                 200   140    40 1.12            0.00                      $0
Bed - Double - Frame                200   140    10 0.28            0.00                      $0
Bed - Double - Head                  70   140    20 0.20            0.00                      $0
Bed - Double - Mattress             200   140    30 0.84            0.00                      $0
Bed - King - Base                   200   180    40 1.44            0.00                      $0
Bed - King - Frame                  200   180    10 0.36            0.00                      $0
Bed - King - Head                    70   180    20 0.25            0.00                      $0
Bed - King - Mattress               200   180    30 1.08            0.00                      $0
Bed - Queen - Base                  200   150    40 1.20            0.00                      $0
Bed - Queen - Frame                 200   150    10 0.30            0.00                      $0
Bed - Queen - Head                   70   150    20 0.21            0.00                      $0
Bed - Queen - Mattress              200   150    30 0.90            0.00                      $0
Bed - Single - Base                 200   100    40 0.80            0.00                      $0
Bed - Single - Frame                200   100    10 0.20            0.00                      $0
Bed - Single - Head                  70   100    20 0.14            0.00                      $0
Bed - Single - Mattress             200   100    30 0.60            0.00                      $0
Bedside Table/Drawers                70    60    60 0.25            0.00                      $0
Bookcase                            180    90    30 0.49            0.00                      $0
Chair                                80    70    60 0.34            0.00                      $0
Chest                                50    90    40 0.18            0.00                      $0
Chest Drawers                       120    90    40 0.43            0.00                      $0
Cheval Mirror                       150    40    20 0.12            0.00                      $0
Computer (in std box)                65    45    45 0.13            0.00                      $0
Cot                                 120   150    90 1.62            0.00                      $0
Desk                                 70   150    80 0.84            0.00                      $0
Dressing Table                       70    90    40 0.25            0.00                      $0
Dressing Table Stool                 50    50    40 0.10            0.00                      $0
Picture/mirror                       60    80    10 0.05            0.00                      $0
Sofa                                 90   140    90 1.13            0.00                      $0
Suitcase                             50    70    30 0.11            0.00                      $0
TV - LCD/Plasma 106cm                80   110    10 0.09            0.00                      $0
Wardrobe                            210   120    60 1.51            0.00                      $0




                          Total                                     0.00                      $0
                                    Sun Room/Office
                 Item       h(cm) w(cm) d(cm) vol      qty   total   value ea   total
> Carton - small               35    45    35 0.06            0.00                      $0
> Carton - standard            65    45    45 0.13            0.00                      $0
> Portable Robe               110    50    60 0.33            0.00                      $0
Bed - Double - Base           200   140    40 1.12            0.00                      $0
Bed - Double - Frame          200   140    10 0.28            0.00                      $0
Bed - Double - Head            70   140    20 0.20            0.00                      $0
Bed - Double - Mattress       200   140    30 0.84            0.00                      $0
Bed - King - Base             200   180    40 1.44            0.00                      $0
Bed - King - Frame            200   180    10 0.36            0.00                      $0
Bed - King - Head              70   180    20 0.25            0.00                      $0
Bed - King - Mattress         200   180    30 1.08            0.00                      $0
Bed - Queen - Base            200   150    40 1.20            0.00                      $0
Bed - Queen - Frame           200   150    10 0.30            0.00                      $0
Bed - Queen - Head             70   150    20 0.21            0.00                      $0
Bed - Queen - Mattress        200   150    30 0.90            0.00                      $0
Bed - Single - Base           200   100    40 0.80            0.00                      $0
Bed - Single - Frame          200   100    10 0.20            0.00                      $0
Bed - Single - Head            70   100    20 0.14            0.00                      $0
Bed - Single - Mattress       200   100    30 0.60            0.00                      $0
Bedside Table/Drawers          70    60    60 0.25            0.00                      $0
Bookcase                      180    90    30 0.49            0.00                      $0
Chair                          80    70    60 0.34            0.00                      $0
Chest                          50    90    40 0.18            0.00                      $0
Chest Drawers                 120    90    40 0.43            0.00                      $0
Cheval Mirror                 150    40    20 0.12            0.00                      $0
Computer (in std box)          65    45    45 0.13            0.00                      $0
Cot                           120   150    90 1.62            0.00                      $0
Desk                           70   150    80 0.84            0.00                      $0
Dressing Table                 70    90    40 0.25            0.00                      $0
Dressing Table Stool           50    50    40 0.10            0.00                      $0
Picture/mirror                 60    80    10 0.05            0.00                      $0
Sofa                           90   140    90 1.13            0.00                      $0
Suitcase                       50    70    30 0.11            0.00                      $0
TV - LCD/Plasma 106cm          80   110    10 0.09            0.00                      $0
Wardrobe                      210   120    60 1.51            0.00                      $0

Office
> Carton - small              35     45    35   0.06          0.00                      $0
> Carton - standard           65     45    45   0.13          0.00                      $0
Bookcase                     180     90    30   0.49          0.00                      $0
Desk                          70    150    80   0.84          0.00                      $0
Filing Cabinet - 4 drawer    120     60    80   0.58          0.00                      $0
                      Total                                       0.00                      $0
                                          Laundry
               Item           h(cm) w(cm) d(cm)     vol    qty   total   value ea   total
> Carton - small                 35    45    35     0.06          0.00                      $0
> Carton - standard              65    45    45     0.13          0.00                      $0
Airer                            15   120    20     0.04          0.00                      $0
Brooms etc (bundle)             150    30    30     0.14          0.00                      $0
Cupboard                         70   120    40     0.34          0.00                      $0
Dryer                            80    65    65     0.34          0.00                      $0
Ironing Board                   120    35    10     0.04          0.00                      $0
Laundry Basket                   30    50    40     0.06          0.00                      $0
Laundry Trolley                  70    50    40     0.14          0.00                      $0
Stool                            70    30    30     0.06          0.00                      $0
Table                            70   150    90     0.95          0.00                      $0
Vacuum Cleaner                  120    45    45     0.24          0.00                      $0
Washing Machine                 110    70    70     0.54          0.00                      $0




                      Total                                       0.00                      $0
                                        Bathroom 1
               Item           h(cm) w(cm) d(cm) vol        qty   total   value ea   total
> Carton - small                 35    45    35 0.06              0.00                      $0
> Carton - standard              65    45    45 0.13              0.00                      $0
Total   0.00   $0
                                              Sundries
                Item               h(cm) w(cm) d(cm) vol     qty   total   value ea   total
> Carton - small                      35    45     35 0.06          0.00                      $0
> Carton - standard                   65    45     45 0.13          0.00                      $0
Car Seat                              80    40     40 0.13          0.00                      $0
Child's Chair                         50    30     30 0.05          0.00                      $0
Computer                              65    45     45 0.13          0.00                      $0
Doll's House                         100    60     40 0.24          0.00                      $0
Golf Bags                            100    40     50 0.20          0.00                      $0
Golf Buggy - collapsed               100    30     30 0.09          0.00                      $0
Heater                                50    70     30 0.11          0.00                      $0
Plastic Crates                        50    50     80 0.20          0.00                      $0
Portable Air Conditioner              70    40     40 0.11          0.00                      $0
Pram - collapsed                     120    80     30 0.29          0.00                      $0
Scooter - collapsed                   80    20     15 0.02          0.00                      $0
Sewing Cabinet                        70    90     40 0.25          0.00                      $0
Skis                                   2    25     25 0.00          0.00                      $0
Suitcases                             50    70     30 0.11          0.00                      $0
Toy Pram                              70    70     30 0.15          0.00                      $0
Trike                                 70    50     80 0.28          0.00                      $0
Trunk                                 50    90     40 0.18          0.00                      $0
Xmas Tree                            180    30     30 0.16          0.00                      $0




                           Total                                    0.00                      $0
                                   Outside Effects
               Item        h(cm) w(cm) d(cm) vol     qty   total   value ea   total
> Carton - small              35    45     35 0.06          0.00                      $0
> Carton - standard           65    45     45 0.13          0.00                      $0
Basket                        70    40     40 0.11          0.00                      $0
BBQ - 4 burner               110   140     65 1.00          0.00                      $0
Bicycle                      100    50    150 0.75          0.00                      $0
Bin                           60    50     50 0.15          0.00                      $0
Blower                        30   100     30 0.09          0.00                      $0
Chair                         80    70     60 0.34          0.00                      $0
Compost Bin                   40    80     40 0.13          0.00                      $0
Cubby House - collapsed       30   120    120 0.43          0.00                      $0
Cupboard                      70    90     30 0.19          0.00                      $0
Dog Kennel                    70    60     70 0.29          0.00                      $0
Esky                          40    40     50 0.08          0.00                      $0
Folding Chairs                20    70    120 0.17          0.00                      $0
Garden Seat                   60    80     40 0.19          0.00                      $0
Garden Tools                 150    40     40 0.24          0.00                      $0
Gym Equipment - cycle        120   100     60 0.72          0.00                      $0
Ladder                       180    60     15 0.16          0.00                      $0
Mower & Catcher               50    50    120 0.30          0.00                      $0
Pot Plant - large            200    70     70 0.98          0.00                      $0
Pot Plant - small             60    30     30 0.05          0.00                      $0
Sand Pit                      20    90     90 0.16          0.00                      $0
Shelving                      30   120     30 0.11          0.00                      $0
Statues                       90    40     40 0.14          0.00                      $0
Surfboard                    180    45     10 0.08          0.00                      $0
Swing - collapsed             40   240     40 0.38          0.00                      $0
Table                         70   240    100 1.68          0.00                      $0
Table Tennis - collapsed      10   240    150 0.36          0.00                      $0
Tool Chest                    40    90     40 0.14          0.00                      $0
Trampoline - collapsed        10   240    180 0.43          0.00                      $0
Wheelbarrow                   70   130     60 0.55          0.00                      $0
Whipper Snipper              150    30     30 0.14          0.00                      $0
Work Bench                    70   120     60 0.50          0.00                      $0
Table                         70    70     70 0.34          0.00                      $0
Umbrella                     100    30     30 0.09          0.00                      $0
                      Total                                     0.00                      $0
                                       Miscellaneous
               Item           h(cm) w(cm) d(cm) vol      qty   total   value ea   total
> Carton - small                 35    45      35 0.06          0.00                      $0
> Carton - standard              65    45      45 0.13          0.00                      $0
Brooms etc (bundle)             150    30      30 0.14          0.00                      $0
Clothing Rack                   150   210      40 1.26          0.00                      $0
Computer                         65    45      45 0.13          0.00                      $0
Market Umbrella                 240    30      30 0.22          0.00                      $0
Ottoman                          50    60      60 0.18          0.00                      $0
Pool Table                       70   180      90 1.13          0.00                      $0
Spin Cycle                      120   100      80 0.96          0.00                      $0
Sports Equipment                 50    30      30 0.05          0.00                      $0
Treadmill                       120   150      80 1.44          0.00                      $0
Umbrella                        100    30      30 0.09          0.00                      $0




                      Total                                     0.00                      $0
                                       Bathroom 2
               Item           h(cm) w(cm) d(cm) vol      qty   total   value ea   total
> Carton - small                 35    45    35 0.06            0.00                      $0
> Carton - standard              65    45    45 0.13            0.00                      $0
Total   0.00   $0
                                         Family Room
              Item              h(cm) w(cm) d(cm) vol     qty   total   value ea   total
> Carton - small                   35    45     35 0.06          0.00                      $0
> Carton - standard                65    45     45 0.13          0.00                      $0
Bar                               120   120     30 0.43          0.00                      $0
Bar Fridge                         80    50     60 0.24          0.00                      $0
Bar Stool                         130    30     30 0.12          0.00                      $0
Bookcase                          180    90     30 0.49          0.00                      $0
Bureau                             70   150     80 0.84          0.00                      $0
Chair                              80    70     60 0.34          0.00                      $0
China Cabinet                     180    90     30 0.49          0.00                      $0
Cocktail Cabinet                   70   120     40 0.34          0.00                      $0
Coffee Table                      100   150     60 0.90          0.00                      $0
Desk                               70   150     80 0.84          0.00                      $0
Entertainment Unit                180    90     40 0.65          0.00                      $0
Heater                             50    70     30 0.11          0.00                      $0
Lamp                              100    40     50 0.20          0.00                      $0
Lounge - 1 seater                  90    90     90 0.73          0.00                      $0
Lounge - 2 seater                  90   140     90 1.13          0.00                      $0
Lounge - 3 Seater                  90   190     90 1.54          0.00                      $0
Magazine tidy                      40    50     30 0.06          0.00                      $0
Pedestal Fan                       90    40     40 0.14          0.00                      $0
Piano - upright                   150   140     50 1.05          0.00                      $0
Piano Stool                        50    50     40 0.10          0.00                      $0
Picture/mirror                    110    80     10 0.09          0.00                      $0
Pouffs                             50    60     60 0.18          0.00                      $0
Rug (rolled)                      240    30     30 0.22          0.00                      $0
TV - LCD/Plasma 106cm              80   110     10 0.09          0.00                      $0
Table                              70    90     90 0.57          0.00                      $0




                        Total                                    0.00                      $0
                                               Kitchen
                Item               h(cm) w(cm) d(cm)      vol    qty   total   value ea   total
> Carton - small                      35    45      35    0.06          0.00                      $0
> Carton - standard                   65    45      45    0.13          0.00                      $0
Bar Stool                            130    30      30    0.12          0.00                      $0
Cabinet                               70    90      30    0.19          0.00                      $0
Chair - dining                        90    40      40    0.14          0.00                      $0
Dishwasher                            70    60      60    0.25          0.00                      $0
Freezer                               90    90      70    0.57          0.00                      $0
Fridge                               160   100      75    1.20          0.00                      $0
High Chair                            90    50      60    0.27          0.00                      $0
Microwave                             40    80      50    0.16          0.00                      $0
Table                                 70   180      90    1.13          0.00                      $0
Tidy                                  50    30      30    0.05          0.00                      $0
double door fridge                   180   120      80    1.73          0.00




                           Total                                        0.00                      $0
                                                 Garage
                 Item              h(cm)   w(cm) d(cm)    vol    qty   total   value ea   total
> Carton - small                      35      45     35   0.06          0.00                      $0
> Carton - standard                   65      45     45   0.13          0.00                      $0
Basket                                70      40     40   0.11          0.00                      $0
Bicycle                              100      50    150   0.75          0.00                      $0
Blower                                30     100     30   0.09          0.00                      $0
Chair                                 80      70     60   0.34          0.00                      $0
Cupboard                              70      90     30   0.19          0.00                      $0
Esky                                  40      40     50   0.08          0.00                      $0
Folding Chairs                        20      70    120   0.17          0.00                      $0
Garden Tools                         150      40     40   0.24          0.00                      $0
Gym Equipment - cycle                120     100     60   0.72          0.00                      $0
Ladder                               180      60     15   0.16          0.00                      $0
Mower & Catcher                       50      50    120   0.30          0.00                      $0
Shelving                              30     120     30   0.11          0.00                      $0
Surfboard                            180      45     10   0.08          0.00                      $0
Table Tennis - collapsed              10     240    150   0.36          0.00                      $0
Tool Chest                            40      90     40   0.14          0.00                      $0
Wheelbarrow                           70     130     60   0.55          0.00                      $0
Whipper Snipper                      150      30     30   0.14          0.00                      $0
Work Bench                            70     120     60   0.50          0.00                      $0
                            Total                                     0.00           $0
                                                Totals
              Room                  h(cm) w(cm) d(cm)    vol   qty   total   total
Lounge                                                                0.00           $0
Hall                                                                  0.00           $0
Dining Room                                                           0.00           $0
Bedroom 1                                                             0.00           $0
Bedroom 2                                                             0.00           $0
Bedroom 3                                                             0.00           $0
Bedroom 4 & Guest                                                     0.00           $0
Sun Room/Office                                                       0.00           $0
Laundry                                                               0.00           $0
Bathroom 1                                                            0.00           $0
Sundries                                                              0.00           $0
Outside Effects                                                       0.00           $0
Miscellaneous                                                         0.00           $0
Bathroom 2                                                            0.00           $0
Family Room                                                           0.00           $0
Kitchen                                                               0.00           $0
Garage                                                                0.00           $0




                            Total                                     0.00           $0
                                          Packing Materials
                                     Cartons
                Room               book std porta
Lounge                                 0     0
Hall                                   0     0
Dining Room                            0     0
Bedroom 1                              0     0      0
                          Ensuite      0     0
                     Walk-in-robe      0     0      0
Bedroom 2                              0     0      0
Bedroom 3                              0     0      0
Bedroom 4 & Guest                      0     0      0
Sun Room/Office                        0     0      0
                            Office     0     0
Laundry                                0     0
Bathroom 1                             0     0
Sundries                               0     0
Outside Effects                        0     0
Miscellaneous                          0     0
Bathroom 2                             0     0
Family Room                            0     0
Kitchen                                0     0
Garage                                 0     0                 tape paper
0   0   0   0   0
                                                              E.J.SHAW REMOVALS
                                                                         ABN 18 133 976 735
                                                             3 Rowe St, Freshwater, NSW 2096
                                                       Ph: (02) 9938 1452, Fax: (02) 9905 0980
                                                               email: ejshaw2096@gmail.com
                                                        Authorised Representative No. 344535


                                                      INSURANCE DECLARATION

  Select your required cover (X):                      Periods Covered                                 Risks Covered                              Basis of Settlement
                                            Transit                                       Full Cover, OR                                 Market Value, OR
                                            Storage                                       Restricted Cover                               Replacement Cost


Use the inventory on previous pages to itemise the value of your goods. If you prefer, you may simply declare the Total Value of your goods.
If you have selected Replacement Cost cover, ensure that you estimate the cost of new goods of similar type. If you have selected Market Value
Cover, estimate the amount which your goods would be worth.
Remember that if you underestimate the value by more than 20%, the amount of your claim may be reduced.


Lounge                                  $0 Bedroom 3                                  $0 Sundries                                   $0 Kitchen                                    $0
Hall                                    $0 Bedroom 4 & Guest                          $0 Outside Effects                            $0 Garage                                     $0
Dining Room                             $0 Sun Room/Office                            $0 Miscellaneous                              $0
Bedroom 1                               $0 Laundry                                    $0 Bathroom 2                                 $0
Bedroom 2                               $0 Bathroom 1                                 $0 Family Room                                $0


                                                                                                                               Total Declared Value                               $0




Valuables: Please list and estimate the value of any antique, curio, piece of jewellery, plate, precious object, work of art, medal, money, coin,
stamp, collection of items, fur, piece of precision equipment or professionally packed carton by the removal company whose value exceeds $1,000
in the table below. Attach a detailed inventory if you need more space.


Specified Item                                                               Value        Specified Item                                                                 Value




Declaration - I declare that the above values are correct to the best of my knowledge and that I have informed the Removal Company about
anything which could affect the risk. I have received a copy of the FSG and PDS.



   SIGNATURE:                                                                                      DATE:


   PRINT NAME:                                           0




Reshaw Pty Ltd trading as EJ Shaw Removals is an authorised representative of Aldridge & Street a Division of Cowden (VIC) Pty Ltd which holds Australian Financial Services Licence
                                                                                    No 245658
Reshaw Pty Ltd trading as EJ Shaw Removals is an authorised representative of Aldridge & Street a Division of Cowden (VIC) Pty Ltd which holds Australian Financial Services Licence
                                                                                    No 245658
dwelling floor   parking y/n
                 n       yes
duplex basement o resrictions
house ground none        no
terrace        1
townhouse      2
unit           3
         lift

				
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