DO YOU KNOW HOW MUCH YOUR POSSESSIONS ARE WORTH?

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(2)

DO YOU KNOW HOW

MUCH

YOUR POSSESSIONS

ARE WORTH?

Broker's or agent's e-mail:

Name of your insurance company:

PERSONAL INFORMATION

To avoid problems later on, use this form to make an inventory of your possessions.

Once completed, contact your insurance broker or agent to obtain adequate coverage.

When you purchase home or damage insurance, it is essential to be able to prove the value of your

assets.

Store a copy of your inventory form in a safe place outside of your home. It is highly

recommended that you include bills, photographs or a video of your assets. Receipts, warranties

and instruction manuals also serve as proof in case of an insurance claim.

Once completed, this inventory form serves as a reminder in case you need to make a claim.

Don’t hesitate to include any other documents that you consider relevant.

Name:

INSURANCE COMPANY INFORMATION

Phone:

Postal code:

City: Province:

E-Mail:

NOTE: Any modification for the purpose of reproducing this document is prohibited without having obtained, in advance, the authorisation of the Insurance Office of Canada and the Chambre de l'assurance de dommages.

Policy number:

Name of broker or agent: Broker's or agent's phone:

First name:

Phone (work): Address:

(3)

Sub-total Section 1 - $

LIVING ROOM

NUMBER OF ITEMS DESCRIPTION SERIAL NUMBER MODEL PURCHASE PRICE (approximate)

Value per unit Total value

Aquarium Furnishings - $ Bookshelves Cabinets - $ - $ Chairs - $ Couches - $ Shelves - $ Sofas - $ Tables - $ Electronic equipment Camcorder - $ Camera - $

Home theatre system - $

Radio - $ Stereo system - $ Telephone - $ Television - $ VCR, DVD player - $ Video games - $ Accessories

Antenna / satellite dish - $

Audio-cassettes - $

Books - $

CDs, records - $

Curtains, draperies and blinds - $

DVDs Lamps - $ - $ Mirrors Musical instruments - $ - $ Paintings Plants - $ - $ Other Videocassettes - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ SUB-TOTAL 1 - $

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- $ - $ SUB-TOTAL 2 - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ Other

Paintings and prints - $

Mirrors - $

Lighting fixtures - $

Cutlery, silverware - $

Crystal - $

Chinaware - $

Carpets and rugs - $

Accessories

Shelves - $

China cabinet and contents Dining room furniture

- $ - $ Cabinets Furnishings - $ Sub-total Section 2 - $

DINING ROOM

NUMBER OF ITEMS DESCRIPTION SERIAL NUMBER MODEL PURCHASE PRICE (approximate)

(5)

Cabinets - $

Appliances

KITCHEN

Sub-total Section 3 - $ NUMBER OF

ITEMS DESCRIPTION

SERIAL NUMBER MODEL PURCHASE PRICE (approximate)

Cupboard and contents

Furnishings - $ Kitchen furniture - $ Dishwasher - $ Freezer - $ Microwave oven - $ Range hood - $ Refrigerator - $ Stove - $ Toaster - $ Water dispenser - $ Accessories Clock - $ Coffee maker - $ Cookware - $

Dishes, kitchen items - $

- $ Kitchen linens, tablecloth,

- $ ice-cream maker, fryer, etc…

Lamps Utensils - $ Electronic equipment Radio - $ Television Other - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ SUB-TOTAL 3 - $ - $ decorations

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(piano, violin, guitar…) Musical instruments

- $

FAMILY ROOM AND REC ROOM

ITEMS DESCRIPTION

Furnishings - $ Bookshelves Furniture - $ - $ Cabinets Accessories - $ Shelves - $ Books - $ Audio-cassettes - $ CDs, records - $ Carpets and rugs

Curtains, draperies and blinds

- $ Closet contents - $ - $ DVD - $ Framed pictures - $ Fireplace accessories - $ Mirrors - $ Lamps - $ Toys - $ Paintings and prints

- $ Videocassettes - $ Video games - $ Home theatre Electronic equipment Stereo system - $ Radio Television - $ - $ Other VCR, DVD player - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ SUB-TOTAL 4 - $

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Other

- $

ENTRYWAY AND HALLWAY

DESCRIPTION _{Value per unit}PURCHASE PRICE (approximate)_{Total value} SERIAL NUMBER_MODEL

Sub-total Section 5 - $ NUMBER OF ITEMS Cabinets Furnishings - $

Accessories and clothes

Chairs - $

Boots, shoes - $

Caots, furs, leather - $

Corrective glasses, sunglasses - $

Gloves, mittens, scarves, toques - $

Raincoat - $ Winter clothes - $ Working clothes - $ Electronic equipment Alarm system - $ Vacuum cleaner - $ - $ Other NUMBER OF ITEMS DESCRIPTION

PURCHASE PRICE (approximate)

Shelves

Furnishings

BATHROOM, LAUNDRY ROOM

- $ SERIAL NUMBER MODEL - $ - $ - $ - $ - $ Valur per unit Total value

SUB-TOTAL 5 - $

Cupboards - $

Mirrors

Accessories

Ironing board and iron

Curtains, draperies and blinds

- $ - $ - $ Washer, dryer Scale - $ Toiletries

Towels and linens

Electric appliances

- $ Rugs and carpets

- $

Cabinets and contents - $

Cupboard contents

Hair dryer, shaver - $

SUB-TOTAL 6 - $

- $

Medecine chest contents - $

- $ Sub-total Section 6 - $ - $ - $

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MASTER BEDROOM

ITEMS DESCRIPTION

Bedroom suite Furnishings - $ Accessories Vanity - $

Bedding and pillows - $

Books - $

Cosmetics, fragrances - $

Duvet and comforter - $

Knick-knacks - $

Lamps - $

Electronic equipment

Fan - $

Humidifier - $

Radio / stereo system / clock radio - $

Television - $

VCR, DVD player - $

Clothing

Backpack, waist packs - $

Business suits, suits, dresses - $

Fine garments - $ Hats, caps - $ Jackets - $ Pants, bermudas Pullover - $ - $

Purses and handbags… - $

Pyjamas, dressing gown Scarves

- $

- $ Shirts and blouses

Skirts - $

- $

Slippers - $

Stocking, socks, underclothing - $

Ties, belts - $ Various accessories - $ Wallets - $ - $ Other - $ - $ - $ - $ - $ - $ - $ - $ SUB-TOTAL 7 - $ - $ - $ - $ - $

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- $ Furnishings Bench / workshop Garden furniture Pool table Accessories Automobile accessories Barbecue Bicycles - $ SUB-TOTAL 8 - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ Vacuum cleaner Other - $ Snow blower - $ Heaters Lawnmower - $ - $ Electric or gas tools

Generator - $ - $ Dehumidifier, humidifier - $

Air purifier, heat exchanger, heat pump - $

Air conditioner - $ Electronic equipment - $ Washing equipment - $ Swimming pool, spa and filter

- $ Sports equipement - $ Shovels - $ Shed - $ Seasonal clothing - $ Gardening tools - $ Fishing or hunting equipment

- $ Christmas decorations - $ Camping equipment - $ - $ - $ - $ - $ - $

BASEMENT AND EXTERIOR

ITEMS DESCRIPTION

Recreational vehicle Hand tools or electric tools Luggage and travel bags

- $ - $ - $ - $ - $

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OTHER BEDROOM A

ITEMS DESCRIPTION

Books - $

Knick-knacks - $

Lamps - $

Electronic equipment - $ Fan - $ - $ Television - $ - $ VCR, DVD player Clothing

Radio / stereo system / clock radio Humidifier

- $ Busines suits / suits

Children's wear - $ - $ - $ Dresses Pants, skirts - $ - $ - $ Purses and handbags

Scarves

- $

Ties Various accessories Other - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ SUB-TOTAL 9 - $ - $

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SUB-TOTAL 10 - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ Other - $ - $ Shirts and blouses

Ties

Various accessories Purses and handbags Scarves - $ - $ - $ - $ Dresses Pants, skirts - $ - $ - $ Busines suits / suits

Children's wear - $

VCR, DVD player

Clothing

Radio / stereo system / clock radio Humidifier Television - $ - $ - $ - $ - $ Fan Electronic equipment

Lamps - $

Knick-knacks - $

Books - $

Accessories Vanity - $ Bedroom suite Furnishings - $

OTHER BEDROOM B

ITEMS DESCRIPTION

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OTHER BEDROOM C

ITEMS DESCRIPTION

Books - $

Knick-knacks - $

Lamps - $

Electronic equipment - $ Fan - $ - $ Television - $ - $ VCR, DVD player Clothing

Radio / stereo system / clock radio Humidifier

- $ Busines suits / suits

Children's wear - $ - $ - $ Dresses Pants, skirts - $ - $ - $ Purses and handbags

Scarves

- $

Ties Various accessories Other - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ SUB-TOTAL 11 - $ - $

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- $

Check the "Limitations" section of your contract

SUB-TOTAL 13 - $

- $ VCR, DVD player

Video camera

Use this space to record the items you did not include in the room-by-room inventory, e.g., jewellery, furs, artwork, collectibles, and so forth.

- $ - $ - $ SUB-TOTAL 12

VALUABLES

SERIAL NUMBER MODEL - $ - $

Value per unit Total value NUMBER OF

ITEMS DESCRIPTION

PURCHASE PRICE (approximate) - $ Other - $ - $ - $ - $ Sewing machine Telephone - $ - $ Photocopier Radio MP3 player - $ Peripherals: printer, scanner, etc.

- $ Pager - $ Fax - $ Electronic agenda - $ Computer - $ - $ Cellphone CD-ROMs - $ Calculator - $ Electronic equipment Software - $

Office supplies - $ Clock - $ Briefcase - $ Books - $ Art materials - $ Accessories Furniture Filing cabinets - $ - $ Bookshelves Furnishings - $

OFFICE

ITEMS DESCRIPTION

- $ Sub-total Section 13 - $ - $ - $ Camera, digital camera, reflex camera,

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Completed by: Date:

NOTES AND COMMENTS

Sub-total 11

- $

Other

0000-0000-0000-0000 0000-0000-0000-0000

Expiration:

Telephone:

Expiration:

Telephone:

Expiration:

QUESTIONS? DON'T HESITATE TO CONTACT US!

+

0000-0000-0000-0000 0000-0000-0000-0000 0000-0000-0000-0000 0000-0000-0000-0000 0000-0000-0000-0000

Expiration:

American Express

MasterCard

Visa

Telephone:

- $

=

Expiration:

Telephone:

Do you have enough coverage for your possessions?

To avoid nasty surprises in the event that you need to make a claim, insure the full value of your possessions.

CREDIT CARDS

INVENTORY GRAND TOTAL

(insurance coverage required)

OVERVIEW: TOTAL COST OF POSSESSIONS BY ROOM

Sub-total 1

Sub-total 2

- $

Living room

Dining room

Sub-total 9

Sub-total 10

- $

Sub-total 12

Sub-total 13

- $

Sub-total 3

Sub-total 4

0000-0000-0000-0000

Telephone:

Expiration:

Sub-total 5

Sub-total 6

- $

Sub-total 7

Sub-total 8

- $

Kitchen

Family room or Rec Room

Other Bedroom C

Office

Entryway and Hallway

Bathroom, Laundry Room

Valuables

Master Bedroom

Basement and Exterior

Other Bedroom A

Other Bedroom B

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