English - INVENTORY OF HOUSEHOLD GOODS by gyvwpsjkko



INSURED (Surname & initials):                                                           BROKER CODE:

It has been our experience, from handling claims, that many of our clients are under-insured due to the event of inflation and
ever-increasing costs. Therefore, in view of the condition of “average”, it is in your best interest to check the adequacy of your
Sum insured by using the following valuation schedule on a “new for old” basis.

1   BEDROOMS                       Bedroom 1    Bedroom 2       Bedroom 3    Bedroom 4       2    LOUNGE AND FAMILY ROOM
Curtains                           R            R               R            R               Curtains                    R
Loose carpets                      R            R               R            R               Loose carpets               R
Paintings & ornaments              R            R               R            R               Paintings & ornaments       R
Bed & mattress                     R            R               R            R               Reading lamps               R
Dressing table                     R            R               R            R               TV & Display cabinets       R
Bedside tables                     R            R               R            R               Lounge suite                R
Wardrobes                          R            R               R            R               Coffee & Tea tables         R
Chairs                             R            R               R            R               Other furniture             R
Linen, blankets & bedding          R            R               R            R               Piano/organ                 R
Men’s clothing                     R            R               R            R               Music instruments           R
Ladies’ clothing                   R            R               R            R               Hi-Fi                       R
Children’s clothing                R            R               R            R               TV set (not portable)       R
Hair dryers & electrical rollers   R            R               R            R               TV set (portable)           R
Make-up & cosmetics                R            R               R            R               Video machine               R
Electric shaver                    R            R               R            R               DVD player                  R
Toys                               R            R               R            R               CD disks                    R
TV sets                            R            R               R            R               Cassettes                   R
Other                              R            R               R            R               Other                       R
Total 1                            R            R               R            R               Total 2                     R

3   BATHROOMS AND TOILETS                   4   JEWELLERY                               5    OUTBUILDINGS
Curtains                      R             Diamond rings            R                  Curtains                     R
Toilet sets                   R             Dress rings              R                  Loose carpets                R
Toiletries                    R             Bracelets                R                  Bed and mattress             R
Towels                        R             Watches                  R                  Linen and bedding            R
Bathroom scale                R             Earrings                 R                  Clothing                     R
Other                         R             Necklace & chains        R                  Other                        R
Total 3                       R             Total 4                  R                  Total 5                      R

6   ENTRANCE HALL & PASSAGES                7   DINING ROOM                             8    STUDY
Curtains                      R             Curtains                 R                  Curtains                     R
Loose carpets                 R             Loose carpets            R                  Loose carpets                R
Paintings                     R             Paintings & ornaments    R                  Paintings & ornaments        R
Ornaments                     R             Table and chairs         R                  Reading lamps                R
Telephone table               R             Dresser & sideboard      R                  Desk & chairs                R
Mirrors                       R             Hot tray                 R                  Bookshelf                    R
Wall clocks                   R             Glassware                R                  Books                        R
Furniture                     R             Silverware               R                  Computer                     R
Linen                         R             Cutlery                  R                  Typewriter                   R
Other                         R             Other                    R                  Other                        R
Total 6                       R             Total 7                  R                  Total 8                      R

9   KITCHEN & LAUNDRY                                                                   10       GARAGE/WORKSHOPS/STORES
Curtains                      R         Table and chairs             R                  Power tools                      R
Stove                         R         Dinner services              R                  Hand tools                       R
Microwave oven                R         Glassware                    R                  Workbench & vice                 R
Fridges                       R         Cutlery                      R                  Welding machine                  R
Deep freezers                 R         Tea and coffee sets          R                  Lawnmower & weed eater           R
Dishwasher                    R         Groceries                    R                  Garden furniture                 R
Washing machine               R         Iron and board               R                  Gardening tools                  R
Tumble dryer                  R         Ornaments                    R                  BBQ equipment                    R
Electrical equipment          R         Other                        R                  Camping equipment                R
Vacuum cleaner                R                                      R                  Bicycles                         R
Polisher                      R                                      R                  Other                            R
Total 9                                                              R                  Total 10                         R
11     OTHER CONTENTS                                           SUMMARY OF TOTALS
Firearms                                           R            Total 1                 R
Bar counter                                        R            Total 2                 R
Wine and spirits                                   R            Total 3                 R
Sewing machine                                     R            Total 4                 R
Knitting machine                                   R            Total 5                 R
Portable radios                                    R            Total 7                 R
Plants                                             R            Total 8                 R
Luggage suite & briefcases                         R            Total 9                 R
Collections                                        R            Total 10                R
Other furniture                                    R            Total 11                R
Other:                                             R            GRAND TOTAL             R
Total 11                                           R


List all electrical equipment exceeding R500.00.

ITEM                                               BRAND NAME           SERIAL NUMBER   VALUE

1                                                                                       R
2                                                                                       R
3                                                                                       R
4                                                                                       R
5                                                                                       R
6                                                                                       R
7                                                                                       R
8                                                                                       R
9                                                                                       R
10                                                                                      R
11                                                                                      R
12                                                                                      R
13                                                                                      R
14                                                                                      R
15                                                                                      R
16                                                                                      R
17                                                                                      R
18                                                                                      R
19                                                                                      R
20                                                                                      R
21                                                                                      R
22                                                                                      R
23                                                                                      R
24                                                                                      R
25                                                                                      R

SIGNATURE:                                                              DATE:

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