How much can you lose? To claim under your insurance policies for loss or damage to your personal property, it is necessary to provide the Adjuster with a complete inventory of the property destroyed or damaged. We suggest you print out and complete this form. While it will take time to fill out, it may save you money, should a serious loss occur. If the total amount of the inventory form comes to more than the amount of your insurance, you will have to contact your Broker to arrange additional coverage. Replacement Cost If your policy provides for this, then us the Estimated Replacement Value column also. If you do not have this and wish details, please contact your Broker. Special Limits Certain property has dollar limitations. Check your policy and if values exceed these limits, then you can arrange specific insurance as required. These items include - jewellery, watches, precious and semi-precious stones, furs, fur garments, garments trimmed with fur, manuscripts, stamps, coins, collectible cards and comic books. Important Keep this inventory in a safe place away from your home.

 

Policy No.	______________________________________
Name	______________________________________
Address	______________________________________ ______________________________________ ______________________________________

 

Living Room
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Bookcase
	Bric-a-brac
	Chair(s)
	Chesterfield
	Clock(s)
	Curtains, drapes
	Hi-Fi stereo
	Lamp(s)
	Musical instruments
	Paintings, pictures
	Piano
	Radio
	Records, cassettes
	Rug(s), carpets
	Table(s)
	TV set
	VCR, CD player
	Other:
	Total		$	$

 

Family-Recreation Room
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Bric-a-brac
	Chair(s)
	Chesterfield
	Curtains, drapes
	Desk
	Lamp(s)
	Rug(s), carpets
	Table(s)
	Other:
	TV set
	VCR
	Hi-Fi stereo
	Total		$	$

 

Kitchen
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Bowls, etc.
	Clock
	Curtains
	Cutlery
	Dinette set
	Dishes
	Dishwasher
	Electric appliances
	Microwave oven
	Pots & pans
	Step-stool
	Stove
	Tables, chairs
	Utensils
	Other:
	Total		$	$

 

Dining Room
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Art, painting, pictures
	Buffet
	Chairs
	China
	China cabinet
	Curtains
	Electric appliances
	Glassware - crystal
	Linens
	Rug(s) & carpet(s)
	Serving table
	Silverware
	Table
	Other:
	Total		$	$

 

Bathroom(s)
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Cosmetics
	Electric appliances
	Medicine cabinet content
	Rugs, bath mats
	Scale
	Shower curtains, drapes
	Other:
	Total		$	$

 

Master Bedroom
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Bedding
	Bed(s)
	Bench
	Chair(s)
	Chest of drawers
	Clock(s)
	Curtains, drapes
	Dressing table
	Lamp(s)
	Mirror(s)
	Night tables
	Radio, television
	Rug(s)
	Toilet Articles
	Vanity
	Other:
	Total		$	$

 

Bedroom No. 2
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Bedding
	Bed(s)
	Bench
	Bric-a-brac
	Chair(s)
	Chest of drawers
	Clock(s)
	Curtains, drapes
	Dressing tables
	Pictures
	Radio, television
	Rug(s)
	Toilet articles
	Vanity
	Other:
	Total		$	$

 

Bedroom No. 3
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Bedding
	Bed(s)
	Bench
	Bric-a-brac
	Chair(s)
	Chest of drawers
	Clock(s)
	Curtains, drapes
	Dressing tables
	Pictures
	Radio, television
	Rug(s)
	Toilet articles
	Vanity
	Other:
	Total		$	$

 

Bedroom No. 4
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Bedding
	Bed(s)
	Bench
	Bric-a-brac
	Chair(s)
	Chest of drawers
	Clock(s)
	Curtains, drapes
	Dressing tables
	Pictures
	Radio, television
	Rug(s)
	Toilet articles
	Vanity
	Other:
	Total		$	$

 

Other Room(s)
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Total		$	$

 

Library or Den
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Bookcases
	Books
	Carpets, rugs
	Chairs
	Drapes
	Computer equipment
	Lamp
	Tables, desks
	Writing equipment
	Other:
	Total		$	$

 

Basement-Garage
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Clothers drier
	Electric appliances
	Freezer
	Fuel
	Furniture
	Games, toys, etc.
	Ironing board
	Tools
	Vacuum cleaner
	Washing machine
	Work bench
	Other:
	Total		$	$

 

Verandah and/or Patio
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Chair(s)
	Dining set
	Glider
	Outdoor cooking equipment
	Sofa
	Table(s)
	Other:
	Total		$	$

 

Sporting-Gardening Equipment
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Bicycles
	Boats, motors, skis
	Fishing equipment
	Garden tools
	Golf clubs, tennis racquets
	Hunting equipment
	Lawn mower
	Swimming pool, equipment
	Other:
	Total		$	$

 

Linens & Clothing
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Blankets
	Face cloths
	Guest towels
	Pillow cases
	Quilts
	Sheets
	Spreads
	Towels
	Belts, gloves
	Blouses
	Boots
	Coats
	Dresses
	Handbags
	Handkerchiefs
	Hats, caps
	Hosiery
	Jackets
	Lingerie
	Pants
	Raincoats
	Rubbers
	Shirts
	Shoes
	Skirts
	Slacks
	Sleepwear
	Slippers
	Socks
	Sport coats
	Sportwear
	Suits
	Sweaters
	Ties
	Underwear
	Total		$	$

 

Jewellery and Furs
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Bracelets
	Coats
	Jackets
	Necklaces
	Neck pieces
	Rings
	Stud - Links
	Watches
	Other Pieces:
	Total		$	$

 

Valuables We would recommend that consideration be given to insuring the following property more specifically under a personal articles floater. Your Broker will be pleased to discuss this coverage.
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Cameras, cine, video
	Furs
	Fine art
	Jewellery
	Musical instruments
	Silverware
	Stamp & coin collections
	Total		$	$

 

Miscellaneous
No.	Item	Year Purchased	Original Cost	Estimated Replacement Value
	Christmas equipment
	Hobby equipment
	Woodworking equipment
	Total		$	$

 

Initial Inventory	______________________________________ Date
Revised	______________________________________ Date

 

Summary
Basement and garage
Bathroom(s)
Bedroom (Master)
Bedroom No. 2
Bedroom No. 3
Bedroom No. 4
Dining Room
Family-recreation room
Jewellery, furs
Kitchen
Linens and clothing
Living room
Other room(s)
Valuables
Verandah or patio
Miscellaneous
Grand Total	$
Present Insurance	$
Addition Insurance Needed	$

 

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