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					                                    PLEASE READ FIRST

      (PLEASE CLICK TAB AT BOTTOM TO COMPLETE SURVEY SELF CERTIFICATION SURVEY FORM

                 Please complete your House Moving Details below then Moving From:

           Complete the Self Cert Survey Form (Please click the TAB at the bottom of the page)

                 Once completed please email back to richard.cundiff@btconnect.com.

   The easiest way to complete the form is to first print it off, then go for a walk around your home, and
 tick off the items which require moving. Once done please enter your results on the Self Cert Survey
                        Form, then email back to richard.cundiff@btconnect.com.

 The Self Cert Survey Form is used to calculate a more accurate size of your move. We appreciate it is
                     difficult to be 100% accurate when listing items to be moved.

           Please be as accurate as possible, as the results of this survey will determine what
                               size vehicle we would use for your move.

               We use Self Cert Survey Form to cut down the cost of surveys, passing on the
savings to our customers, we also use the form to allow us to use the most efficient vehicle based on the
                                  total size of the items to be moved

          Once we receive your form back we will call you to discuss your move in more detail.

                If you require any help completing this form then please contact us on:
                                             0161 487 4880
                              SELF CERTIFICATION SURVEY FORM


                                            Moving From:



                          Customer:

                            Address:

                              Tel No:

                               Email:

                           Property:

If flat, which Floor & Lift Available?


                                             Moving To:



                  Distance if known:

                            Address:

                              Tel No:

                           Property:

If flat, which Floor & Lift Available?



                                         Move Requirements:



          Storage & Term Location?



          Packaging Requirements:



        Special items to be packed:


                                         We offer Goods in Transit Insurance, this cover will only insure
                                         items packed by our Removal Company or Contractors, Owner
                                                        Packed items are not covered.


     Items to dismantle/assemble?



Any Access issues at Either Property?


                      Date Of Move?
Lounge / Dining Room                              Kitchen
                       cu ft   QTY   Office Use                              cu ft   QTY   Office Use
Upright Piano            40                       Washing Machine              15
Baby Grand Piano         40                       Tumble Dryer                 15
Keyboard & Stand         20                       Fridge                       14
Piano Stool                5                      Fridge / Freezer             24
Armchair                 23                       American Style F/Freezer     30
Recliner Armchair        25                       Cooker                       12
2 Seater Sofa            31                       Dishwasher                   15
3 Seater Sofa            45                       Chest Freezer                25
Footstool                  5                      Vacuum Cleaner                 2
Rocking Chair            20                       Microwave                      1
Wall Unit 6’ x 3’        36                       Kitchen Table Small          15
China Cabinet Small      15                       Kitchen Table Large          30
China Cabinet Large      40                       Kitchen Chairs                 4
Welsch Dresser           50                       Hostess Trolley                7
Sideboard 5’ x 3’        30                       Iron / Ironing Board           7
Sideboard 4’ x 3’        24                       Clothes Airer                  3
Dining Table 6’          50
Dining Table 4’          40                       Office / Study
Occasional Table         20                       Office Desk                  35
Dining hairs               5                      Small PC Desk                15
Carver Chair               8                      Office Chair                   5
Bureau Desk              20                       Filing Cabinet               10
Bookcase 6’ x 3’         27                       Double Filing Cabinet        10
Bookcase 5’ x 3’         22                       PC, Monitor & Base Unit        5
Bookcase / CD Rack         5                      Printer                        1
Grandfather Clock        15                       Sewing Machine                 2
Coffee Table             15                       Shelf Unit                   10
Curtain Poles              5                      Cupboard                     25
Lamp                       2
Rug Large                10                       Boxes
Rug Small                  5                      Small Box 15”x15”x9”        1.5
Mirror                  1.5                       Med Box 15”x15”x12”         2.5
Picture                 1.5                       Large Box 23”x15”x15”          4
                                                  Suitcases                      5
Electrical Equipment
Entertainment Unit       25
Portable TV                1
Television 25” - 32”       5
Television 37”             7
Projection TV            10
LCD / Plasma TV            5
Video / DVD Player      0.5
TV Stand                   8
Column Total                    0        0        Column Total                        0        0
Bedrooms                                              Outdoor Items
                           cu ft   QTY   Office Use                             cu ft   QTY   Office Use
Single Bed                   36                       Garden Table                20
Double Bed                   45                       Garden Chairs                 5
Kingsize Bed                 52                       Large Umbrella              10
Chest of Drawers             26                       Swing Seat                  30
Single Wardrobe              27                       Hammock                     20
Double wardrobe              54                       Sun Lounge                  10
Triple Wardrobe              65                       Picnic Bench                25
Nureau / Dresser             25                       Barbeque                    10
Storage Ottoman              20                       Children’s Swing            25
Tallboy                      33                       Children’s Slide            25
Bedside Cabinet                5                      Wendy House                 40
Bookcase                     20                       Wheel Barrow                10
TV & Shelf                     5                      Lawn Mower Sit Down         30
                                                      Lawn Mower Normal           10
Nursery                                               Hose and Reel                 3
Child’s Cot                  25                       Dustbin / Compost             5
Child’s Bath                   5                      Ladders                     20
Child’s Chair (Hi-Chair)       3                      Work Bench                    7
Child’s Bed                  20                       Plants & Pots                 3
Toy Chest                      7                      Adult Bicycle               15
Bunk Bed                     50                       Child’s Bike                10
Boxes of Toys                  5                      Power Tools                   1
                                                      Tool Cabinet                10
Spare Room                                            Car Ramps                     5
Futon                        30
Folding Bed                  40                       Other Outdoor Items Not Listed
Clothes Rails                  5
Storage Boxes                  5
Running Machine              20
Weighted Workout Bench       25
Exercise Bike                20
Stepper Machine              20


Other Indoor items Not Listed


                                                      Boxes
                                                      Small Box 15”x15”x9”       1.5
                                                      Med Box 15”x15”x12”        2.5
                                                      Large Box 23”x15”x15”         5
                                                      Suitcase                      8
                                                      Bin Bags                      3
                                                      Sports Bag / Holdall          3
Column Total                        0        0        Column Total                       0        0
                                                                                        QTY     Size
                                                      Size of your move cu ft            0        0
                                                      Size of your move m3               0      0.00

				
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