APPLICATION FOR ALL RISK PROTECTION COVER

For international, local and storage shipments

Title
First Name
Last Name
Packing Date
Owner Packed
Professionally Packed
Mode of Transport
Moving from City and Country  
Moving to City and Country  
   
This is an Item by Item Protection Cover

Use the list in this form to value all items included in your shipment.


Please ensure you read through the below instructions:
  1. Do not include bank & treasury notes, firearms, furs, jewellery (including precious metals and stones), money, perishables (e.g. make up, perfumes, food) plants, securities, stamps, watches or weapons, as these items are excluded from the Protection Cover. (see exclusions for further details)
  2. Do not include more than EUR 10,000 worth of wine/ liquor or more than EUR 100,000 of fine arts
  3. Enter the cost of your move if you are covering your shipping costs
  4. It is required that this form is completed prior to packing
  5. Items not declared and /or valued will not be covered

Note: Note: Please do not delete the zeros unless these are being replaced with a value


Note: Please do not delete the zeros unless these are being replaced with a value

AUTOMOBILES
VEHICLE TYPE YEAR MODEL CHASSIS NUMBER COVER VALUE
Note: non factory-installed auto accessories must be seperately listed and valued
      AUTOMOBILES TOTAL
QTY ITEM TOTAL VALUE QTY ITEM TOTAL VALUE QTY ITEM TOTAL VALUE
1 LOFT/BASEMENT 4 CLOTHING - MENS 8 BEDROOM 3
XMAS DECORATIONS SUITS BEDS
SEASONAL ITEMS SHIRTS CHAIRS
TROUSERS LAMPS and SHADES
SHORTS CHEST OF DRAWERS
SWEATERS BEDSIDE TABLES
2 MASTER BEDROOM COATS / JACKETS CARPETS / RUGS
BEDS SHOES WARDROBES
CHAIRS BOOTS CURTAINS
LAMPS and SHADES TIES
CHEST OF DRAWERS NIGHTWEAR 9 BEDROOM 4
BEDSIDE TABLES SOCKS / UNDERWEAR BEDS
DRESSING TABLES SPORTSWEAR CHAIRS
CARPETS / RUGS HATS LAMPS and SHADES
WARDROBES CHEST OF DRAWERS
PICTURES / MIRRORS BEDSIDE TABLES
CURTAINS 5 BATHROOM CARPETS / RUGS
RUGS / MATS WARDROBES
TOWELS CURTAINS
CABINETS / SHELVES
TOILETRIES 10 CLOTHING CHILDREN
MIRRORS SHIRTS
3 CLOTHING WOMEN TROUSERS
BLOUSES SKIRTS
DRESSES 6 BEDROOM2 DRESSES
SKIRTS BEDS NIGHTWEAR
TROUSERS CHAIRS COATS / JACKETS
SHORTS LAMPS and SHADES UNDERWEAR
SHOES CHEST OF DRAWERS SHOES / BOOTS
BOOTS BEDSIDE TABLES SWEATERS
COATS / JACKETS CARPETS / RUGS
HOSIERY / SOCKS WARDROBES 11 TOYS / GAMES
UNDERWEAR CURTAINS
NIGHTWEAR
SPORTSWEAR
SWEATERS 12 PERSONAL ITEMS
SCARVES LUGGAGE / SUITCASES
HANDBAGS 7 LINEN TOYS
HATS TABLE LINEN CHILD CAR SEATS
BED LINEN PRAMS / STROLLERS
TOWELS
BLANKETS / DUVETS
TOTAL 1 TOTAL 2 TOTAL 3
QTY ITEM TOTAL VALUE QTY ITEM TOTAL VALUE QTY ITEM TOTAL VALUE
13 LIVING ROOM 17 UTILITY ROOM 23 FRAGILE ITEMS
SOFA WASHING MACHINE CRYSTAL / GLASS
CHAIRS DRYER
CARPETS / RUGS IRON / IRONING BOARD
CURTAINS VACUUM CLEANER
PICTURES
CLOCKS 18 SPORTS EQUIPMENT
TELEPHONE GOLF CLUBS ANTIQUES / ARTWORK
CABINET / BOOKCASES GOLF TROLLEY
BOOKS SKIS
MIRRORS SKI BOOTS
LAMPS and SHADES GYM EQUIPMENT
TABLES
19 PHOTOGRAPHIC
CAMERAS ORNAMENTS
VIDEO EQUIPMENT
14 FAMILY ROOM / STUDY
SOFA 20 MUSICAL INSTRUMENTS
CHAIRS PIANO
TABLES
DESK
CARPETS / RUGS SILVERWARE
LAMPS and SHADES 21 GARDEN / GARAGE
CABINET / BOOKCASES BARBEQUE
PICTURES SWINGS
CLOCKS TABLES
CURTAINS CHAIRS AND BENCHES
BOOKS GARDEN TOOLS 24 MISCELLANEOUS
LAWN MOWER POOL TABLE
HOSE
15 DINING ROOM / STUDY GARDEN TOYS
CHAIRS SAWS
TABLES DRILLS
BUFFET TOOLSET
CHINA CABINET BICYCLES
CARPETS / RUGS LADDERS
CHINA 25 OFFICE ITEMS
PICTURES SAFE
CLOCKS 22 ELECTRICAL / HI-FI
MIRRORS HOME CINEMA
LAMPS and SHADES CD PLAYER
CURTAINS TUNER
AMPLIFIER TOTAL 6
DOCKING STATION HIGH VALUE ITEMS
SPEAKERS
16 KITCHEN TV
COOKER DVD PLAYER
MICROWAVE OVEN RADIO
DISHWASHER SEWING MACHINE
REFRIGERATOR COMPUTER + MONITOR
FREEZER PRINTER
FOOD PROCESSOR OTHER HARDWARE
OTHER APPLIANCES COMPUTER SOFTWARE TOTAL HIGH VALUE ITEMS
TABLE LAPTOP  
CHAIRS DVDs AUTOMOBILES
CUTLERY / UTENSILS CDs TOTAL 1
POTS / PANS SMALL APPLIANCES TOTAL 2
LINENS TOTAL 3
CHINA AND DISHES TOTAL 4
GLASSWARE TOTAL 5
TOTAL 6
TOTAL 4 TOTAL 5 TOTAL HIGH VALUE ITEMS
  SHIPPING COSTS (optional)
  TOTAL TO BE INSURED
CURRENCY

      Terms & Conditions
      

I have read and agree to the terms and conditions *

Declaration of the Proposer

I declare that I have disclosed all material facts and understand that failure to do so could render my enrolment and coverage void.  I declare that the amounts stated above are the full value of the goods at destination.  I confirm that I have declared all items that I wish to be covered with all details requested.  I have read the conditions stated overleaf and understand that these shall form the basis of my enrolment in the All Risk Protection Policy.

 

 

Please select a Santa Fe Relo office you want to submit this form to

Note: This should be the office you have booked your relocation with.

 

I want to receive a copy of my enrolment form

 

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