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TOTAL LOSS ONLY

I have chosen to insure for TOTAL LOSS ONLY. I understand that there is no coverage for partial damage to my shipment.

No, please take me back to ALL RISK option.

Moving Information

Remember the Following:

The terms and conditions of the insurance certificate, including exclusions, are noted on the following page: Policy Exclusions.


ITEMS NOT DECLARED AND VALUED ARE NOT INSURED

TAKE INTO CONSIDERATION WHAT YOUR ITEMS WILL BE WORTH AT YOUR NEW RESIDENCE, NOT WHAT THEY’RE WORTH BEFORE THEY’RE SHIPPED.

DO NOT DISPOSE OF OR DISCARD ANY ITEM WITHOUT WRITTEN AUTHORIZATION

Value Your Inventory

INSURANCE WILL ONLY COVER ITEMS LISTED AND VALUED ON THIS FORM. The terms and conditions of the insurance certificate, including exclusions, are noted on the following page: Policy Exclusions

ITEMS NOT DECLARED AND VALUED ARE NOT INSURED

TAKE INTO CONSIDERATION WHAT YOUR ITEMS WILL BE WORTH AT YOUR NEW RESIDENCE, NOT WHAT THEY’RE WORTH BEFORE THEY’RE SHIPPED.

DO NOT DISPOSE OF OR DISCARD ANY ITEM WITHOUT WRITTEN AUTHORIZATION

ANTIQUES

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KITCHEN/UTILITY ROOM

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DINING ROOM

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FAMILY ROOM/STUDY

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LIVING ROOM

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HALLS/STAIRS/LANDING

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BEDROOM #1

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BEDROOM #2

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BEDROOM #3

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BEDROOM 4 & 5

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CLOTHING - LADIES

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CLOTHING – MENS

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CLOTHING - CHILDRENS

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LINENS

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SPORTS EQUIPMENT

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PERSONAL BELONGINGS

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GARDEN/BASEMENT/GARAGE

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MACHINERY

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ELECTRONICS

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MUSICAL INSTRUMENTS

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COLLECTIONS/FIGURINES

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Additional Coverage

Mold & Mildew*

To include loss or damage in respect to mold & mildew to the interest insured, subject to goods being professionally packed.

Mechanical & Electrical Derangement*

To include loss or damage to the interest insured which is caused by electronic and/or electrical and/or mechanical derangement, provided the interest insured is less than 6 years old. Subject to the goods being professionally packed.

Pairs & Sets Coverage*

In the event of loss or damage recoverable to any item or items forming part of a pair or set, the indemnity afforded by this policy shall be limited to the reasonable and fair reduction in value of the pair or set by reason of the loss or damage to the affected items. All the articles constituting the pair or set shall, at Underwriters option become their property in the event that the Underwriters agree to pay the total loss of the pair or entire set.

Mold & Mildew List Items & Values*

Mechanical & Electrical List Items & Values*

Pairs & Sets List Items & Values*

Premium Calculation

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Mold and Mildew Amount

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Mechanical & Electrical Amount

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Pairs and Sets Amount

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Total Premium

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Policy Exclusions
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