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Make copies of this form to list all of your belongings. Name: Policy Number: Date: |
| Room/Location | Item Description and Quantity |
Purchase Date |
Place of Purchase |
Original Cost |
Estimated Current Value |
Serial#/Model# (or other details) |
Receipt or Photo? |
| Living Room | Antiques | ||
| Artwork | |||
| Dining Room | Bikes | ||
| Calculator | |||
| Kitchen | China/Glassware | ||
| Clocks | |||
| Bathrooms | Collectibles | ||
| Craft/Hobby Materials | |||
| Bedrooms | Electrical Appliances* | ||
| Electrical Equipment | |||
| Family Room/Den | Figurines | ||
| Golf Equipment | |||
| Laundry/Utility | Guns | ||
| Jewelry | |||
| Hallways | Linens | ||
| Musical Instruments | |||
| Carport | Photography | ||
| Silverware/Goldware | |||
| Storage Building | Skis | ||
| Stereo Equipment | |||
| Porch/Deck | Tape Recorder | ||
| Tools | |||
| Tool Shed | Vacuum Cleaner | ||
| Video Equipment | |||
| Yard | Watches | ||