Personal Property Inventory Form - short form

USING THIS FORM

Complete this form on an annual basis to keep an accurate list of your personal belongings for your records. This form may also be used to help you determine the amount of insurance you need to cover your contents. Go through your home room by room and make a list of the items in it. Try to fill in the information requested and be as detailed as possible.

Taking pictures or a video of the contents of your home is also very important. Pay special attention to the most valuable items. Take shots from multiple angles on those items. The contents of covered outbuildings should also be listed.

You should save receipts and warranties whenever possible. Place those, the photos/video of your home and this form in a safe location away from your home (e.g., a safety deposit box).

Please note: Make sure to list expensive valuables in detail as individual items.

In the event of a loss, additional information and documentation will be required. This form may simply give you a head start on the process.

HOW TO FILL IN THE FORM

Quantity List the number of items you have.

Item List what the item is called.

Description Include the manufacturer or the brand name of the item. Also list the model or serial number if applicable. On electronics, list very specific information (i.e., the amount of RAM in your PC).

Where Purchased List the store or location of purchase if you know it. You may want to indicate if the item was a gift.

Personal Property Inventory Form

Purchase Cost List the amount paid for the item. If it was a gift, you should indicate $0.

Date of Purchase or Age List the date the item was purchased. A month and year is sufficient. If you do not recall the date, list the approximate year.

Current Replacement Cost Fill this in to the best of your ability at the time of completion. This may help you determine the amount of insurance coverage you need on your contents.

PLEASE NOTE

Your policy contains exclusions and limitations on certain types of property. You should visit with your agent to determine if additional coverage is needed.

IN THE EVENT OF A CLAIM

Coverage may be void for any Insured who has intentionally concealed or misrepresented any material fact or circumstance relating to this insurance. You will be required to complete new inventory forms at the time of loss. The inventory forms prepared prior to a loss are to be used solely to assist you in preparing current inventory forms in the event of a loss. Purchase receipts should be retained in order to help you document your loss

_______________________________________ Name of Policyholder

_____________ Date Completed

Quantity

In the event of a loss, you will be required to complete new inventory forms.

Item

Description (Mfr/Brand, model/serial number)

Where Purchased

Purchase Cost

Date of Purchase

or Age

Current Replacement

Cost

TOTAL

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