The document is a Declaration of Values for personal and household effects to be covered by insurance, administered by Inter Trans Insurance Services, Inc. It outlines the requirements for declaring values, exclusions from coverage, and the process for filing claims. Additionally, it specifies that insurance coverage is contingent upon proper declaration and valuation of items, and provides details on the limitations and conditions of coverage.
The document is a Declaration of Values for personal and household effects to be covered by insurance, administered by Inter Trans Insurance Services, Inc. It outlines the requirements for declaring values, exclusions from coverage, and the process for filing claims. Additionally, it specifies that insurance coverage is contingent upon proper declaration and valuation of items, and provides details on the limitations and conditions of coverage.
The document is a Declaration of Values for personal and household effects to be covered by insurance, administered by Inter Trans Insurance Services, Inc. It outlines the requirements for declaring values, exclusions from coverage, and the process for filing claims. Additionally, it specifies that insurance coverage is contingent upon proper declaration and valuation of items, and provides details on the limitations and conditions of coverage.
The document is a Declaration of Values for personal and household effects to be covered by insurance, administered by Inter Trans Insurance Services, Inc. It outlines the requirements for declaring values, exclusions from coverage, and the process for filing claims. Additionally, it specifies that insurance coverage is contingent upon proper declaration and valuation of items, and provides details on the limitations and conditions of coverage.
DECLARATION OF VALUES OF PERSONAL AND HOUSEHOLD EFFECTS TO BE COVERED
This form is not an insurance certificate. Insurance must be issued by your agent for coverage to be in effect. Please contact your agent for a copy of the insurance certificate. 1. 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 last page of this form. 2. Miscellaneous items valued at under USD$500.00 may be grouped together. In the event of a claim, grouped items will be averaged. HIGH VALUE ITEMS VALUED AT OVER USD$500.00 PER ITEM OR SET MUST BE SPECIFICALLY DECLARED AND VALUED. Failure to comply will limit recovery to a maximum of USD$500.00 per item or set. 3. You should be aware of the fact that the replacement value of your goods at the final destination might be higher than at origin. Insure your shipment accordingly as it will be co-insured if adequate protection has not been secured. All items in the shipment must be insured. Any policy that covers only a limited number of items in the shipment may be subject to rejection, co-insurance or an average will apply. 4. Do not list jewelry, cash, watches, stamps, negotiable instruments or items of a similar nature as they are excluded from coverage. Additional exclusions are noted on the last page of this form. 5. No one item and/or set can be more than 50% of the total insured value. 6. Use of a separate valued inventory is acceptable to the underwriters. If you have completed another inventory, sign and date this form and attach your personal list. 7. If a particular item is not shown on this form, please add it to either a blank space in the appropriate section or to Section U, Miscellaneous. Attach separate sheets if necessary. (Rev: 07/2021)
A. LIVING ROOM B. DINING ROOM C. FAMILY ROOM
QTY ARTICLE VALUE QTY ARTICLE VALUE QTY ARTICLE VALUE Sofas Table Tables Tables Chairs Chairs Chairs China cabinet Sofa Footstool/ottoman Buffet Desks Divider/screen Server Rugs/carpets Entertainment center Secretary Curtains/draperies Wall unit Rugs/carpets Lamps Rugs/carpets Curtains/drapes Pictures Curtains/draperies Pictures Mirrors Lamps Mirrors Clocks Pictures Lamps Bookcases Mirrors Chandelier Entertainment center Stereo Clocks Wall unit Stereo cabinet China Bar Television Glassware/crystal Televisions Radio Silverware Stereo Clocks Linens Speakers Fireplace tools Tape player/VCR Bric-a-brac Pool table
Page 2 of 5 D. KITCHEN H. MASTER BEDROOM K. BEDROOM #3 QTY ARTICLE VALUE QTY ARTICLE VALUE QTY ARTICLE VALUE Refrigerator Beds Beds Freezer Mattresses/springs Mattresses/springs Range Bedside tables Bedside tables Dishwasher Dressers Dressers Microwave Armoire/wardrobe Armoire/wardrobe Table/chairs Futons Futons Pots/pans Chests Chests Dishes Vanities Vanities Glassware Dressing tables Dressing tables Utensils Chairs Chairs Silverware Bookcases Bookcases Small appliances Rugs/carpets Rugs/carpets Food Curtains/draperies Curtains/draperies Lamps Lamps Pictures Pictures Clocks Clocks Mirrors Mirrors Television Television Radio Radio E. BATHROOMS QTY ARTICLE VALUE Sundries/toiletries Linens Hamper I. BEDROOM #2 L. CLOTHING - MENS Scales QTY ARTICLE VALUE QTY ARTICLE VALUE Shower curtains Beds Suits Cosmetics Mattresses/springs Sports jackets Medical items Bedside tables Coats Dressers Dress shirts Armoire/wardrobe Sports shirts Futons Trousers Chests Sweaters Vanities Ties Dressing tables Shoes/boots F. LINENS Chairs Socks/underwear QTY ARTICLE VALUE Bookcases Sportswear Sheets Rugs/carpets Pillow cases Curtains/draperies Blankets Lamps Bedspreads Pictures Quilts Clocks M. CLOTHING - WOMENS Mirrors QTY ARTICLE VALUE Television Dresses Radio Suits Blouses Skirts Trousers G. ANTIQUES Sweaters QTY ARTICLE VALUE J. COLLECTIONS/FIGURINES Shoes/boots QTY ARTICLE VALUE Coats/jackets Underwear Sportswear Handbags
Page 3 of 5 N. CLOTHING - CHILDRENS R. GARDEN/PATIO Total Column A QTY ARTICLE VALUE QTY ARTICLE VALUE Total Column B Blouses Hand tools Skirts Garden hoses Total Column C Dresses Wheelbarrows Total Column D Coats/jackets Lawn mower Shirts Chairs Total Column E Trousers Tables Total Column F Shoes/boots Swing/glider Sweaters Gym set Total Column G Socks/underwear Barbecue Total Column H Sportswear Nightwear Total Column I Total Column J Total Column K S. GARAGE Total Column L QTY ARTICLE VALUE O. SPORTS EQUIPMENT Tool chests Total Column M QTY ARTICLE VALUE Hand tools Total Column N Fishing tackle Power Tools Total Column O Guns Work Bench Golf clubs Total Column P Tennis racquets Total Column Q Bicycles Gym equipment Total Column R Total Column S T. PERSONAL BELONGINGS QTY ARTICLE VALUE Total Column T Luggage Total Column U P. MUSICAL INSTRUMENTS Toys/games QTY ARTICLE VALUE Video games Total Column V Piano Books Grand Total: Organ Typewriter Elec. keyboards Cameras Currency: Camera equip. Christmas items ADDITIONAL COVERAGE Added coverage, excluding autos, is Q. ELECTRICAL ITEMS available for an additional premium. QTY ARTICLE VALUE Please indicate your acceptance or Vacuum cleaner declination by checking the Sewing machine appropriate boxes below. Air conditioner Accept Decline Dehumidifier U. MISCELLANEOUS Pairs Computers QTY ARTICLE VALUE & Sets Printers Mechanical Monitors & Electrical Modems Software I have read and understand the Supplies terms and conditions as noted on Fax machine all pages of this form. (Rev: 07/2021) Copier Washing Machine V. AUTOMOBILE Dryer Year Signature Iron Make Model Date Vin # Value
Page 4 of 5 PERSONAL AND HOUSEHOLD EFFECT SHIPMENT TERMS AND CONDITIONS INSURANCE WILL NOT COVER ANY CLAIM FOR: (A) loss or damage arising out of the acts of any government, customs authority or official confiscation. Consequential losses due to delay or any depreciation in value are not covered. (B) items missing from owner packed (PBO) or condition unknown (CU) cartons. Claims will not be honored for the loss of any PBO or CU carton unless the shortage has been noted at the time of delivery and reported to I.T.I. within 45 days of delivery. (C) loss due to damage or breakage of items in owner packed (PBO) or condition unknown (CU) cartons, crates, or containers. (D) loss or damage to jewelry, watches, gems, stones, petrified wood, fossils, cash, currency or bank notes, deeds, traveler’s cheques, coin or stamp collections, alcoholic beverages, negotiable items, contraband, prescription drugs or other like items. (E) loss or damage caused by wear and tear, changes in climatic conditions, infestations or inherent vice. (F) any internal electrical or mechanical component of any device unless exceptions are noted at the time of delivery for external damage to such property. Loss of data, manufacturer defects, recalibration, wear and tear are also excluded. Electrical or mechanical malfunctioning coverage, excluding vehicles, is available for a nominal additional premium to cover internal transit related damages. (G) loss or damage to any item unless the premium for the insurance has been received by I.T.I. (H) loss or damage to vehicles while being driven under their own motive power except while on the premises of the port. (I) marring, denting, chipping or scratching on automobiles, motorcycles or other motor vehicles over three years old. (J) non-factory installed accessories or removable items on vehicles. Goods of a personal nature shipped inside vehicles are also excluded. (K) wrinkled or soiled clothing, linens, drapes and rugs. (L) marring, scratching, denting, chipping or rubbing on items which have been received by the carrier as condition unknown. (M) concealed missing or non-delivery of a shipping package if the delivery receipt shows that the package(s) was delivered to the final destination. (N) items not listed on the inventory prepared at origin. Items not shipped are not insured. (O) appraisal fees, shipping charges, damages caused during assembly or disassembly, items having no commercial value, items of sentimental value or property damage. (P) an entire set if any single item(s) is lost or damaged. Payment will only be made for the proportionate value of the item(s) lost or damaged. Pairs and sets coverage is available for a nominal additional premium to cover transit related damages. (Q) loss caused by nuclear reaction, radiation or radioactive contamination, whether controlled or uncontrolled, however caused. (R) physical loss or damage to the property carried out for political, terroristic or ideological purpose when property is in storage. (S) loss and/or damage on door to port shipments unless exceptions are noted when the shipment is received at the port of discharge or shipments delivering to a self-storage facility unless exceptions are noted when the shipment is received at the self-storage facility. (T) loss or damage to plasma televisions, plasma monitors or like plasma items. (U) structural damage to system or kit furniture constructed of veneered chipboard or similar, or any reduction in the quality thereof arising as the result of dismantling or reassembly of any such items of furniture. (V) experimental or prototypical vehicles. (W) loss or damage attributable to fumigation or contamination of the shipment from any cause. (X) loss or damage to live or perishable items.
If underwriters replace, make a total loss payment or pay the insured amount as shown on the valued inventory for a damaged article, they, at their option, have the right to salvage the damaged article. The insurance company reserves the right to inspect and verify all reported damages and to require substantiation of any claimed amounts, values of items claimed or proof of ownership.
Coverage includes 90 days storage at origin and/or destination within an approved warehouse. Mini storages, self-lock areas, garages and other like facilities are not considered approved warehouses. Should the storage period exceed 90 days, the assured or the assured’s agent must promptly notify I.T.I. of the delay and pay an additional premium.
CLAIMS MUST BE SUBMITTED ONLINE TO I.T.I. WITHIN 45 DAYS OF DELIVERY AT WWW.INTERTRANSINS.COM.
Pictures and estimates are required for damaged items. Estimate fees are not covered. The disposal or additional transportation of any damaged item(s) is prohibited unless approval has been obtained from I.T.I. or your claim has been completed. All claim payments, minus any applicable deductible, will be made in U.S. Dollars and will be based on the exchange rate in effect at the time the shipment is declared to I.T.I. The claim settlement will be the lesser of repair costs, replacement costs, or as stated on the valuation form. Underwriters will not pay more than 50% of the insured value for repairs and/or loss of value. All packed items will be considered condition unknown (CU) if insurance is not issued for the date of packing or pickup, whichever comes first. (Rev: 07/2021)
