WORLD WIDE TRANSPORTATION INSURANCE SPECIALISTS

APPLICATION and DECLARATION
If you elect to insure your shipment for replacement cost, all items must be noted and valued.
Items not listed on the valued inventory are not insured. Under no circumstances will coverage attach for more than the value noted. If you do not complete a valued inventory, your shipment will be covered for actual cash value, which is replacement cost less depreciation. Both options are subject to 100% co-insurance. Items grouped together are considered to be of equal value.

This information is being sent to your mover via email. Their email address is required.

Named Insured:	Name of Mover: Mover Email Address:	Mode of Shipment: Land Sea Air
Origin:	Destination:	Deductible Amount:	Pick Up Date:

ARTICLES OWNED
QTY	LIVING ROOM	VALUE
	Bookcase
	Bookshelves. Sectional
	Chair, Arm
	Chair, Occasional
	Chair, Overstuffed
	Chair, Rocker
	Chair, Straight
	Clock, Grandfather / Grandmother
	Clock, Table
	Curtains / Drapes
	Desk
	DVD Player(s)
	Entertainment Center
	Fireplace Equipment
	Figurines
	Foot Stool
	Hide-a-bed, Studio Couch
	Lamp, Floor
	Lamp, Table
	Loveseat
	Magazine Rack
	Mirror(s)
	Painting(s)
	Piano
	Radio
	Rug(s)
	Sofa, 3-seater
	Sofa, Sectional
	Stereo Equipment
	Table, Coffee or End or Nesting
	Table, Drop-leaf or Occasional
	Television, Floor Model
	Television, Table Model
	VCR
	Video Game Unit(s) / Games

QTY	DINING ROOM	VALUE
	Buffet
	Cabinet, Corner
	Chair(s)
	China
	China Closet
	Curtains / Drapes
	Crystal
	Linens / Table
	Mirror(s)
	Painting(s)
	Server
	Silverware
	Table and Extension(s)
	Tea Cart
	Rug(s)

QTY	CLOTHING / SHOES	VALUE
	Women's Clothing
	Men's Clothing
	Children's Clothing / Shoes
	Women's Shoes
	Purses / Accessories
	Men's Shoes
	Furs (Must be itemized and detailed)

QTY	BEDROOMS	VALUE
	Bed including Springs / Mattress:
	{ Bed, Bunk (set of 2)
	{ Bed, Double
	{ Bed, King size
	{ Bed, Queen size
	{ Bed, Single or Hollywood
	{ Bed, Water
	Bench, Dresser or Vanity
	Blanket
	Bookcase
	Bureau / Dresser / Chest
	Cedar Chest / Hope Chest
	Chair, Boudoir
	Chair Straight / Rocker / Glider
	Chaise Lounge
	Curtains / Drapes
	Dresser, Double (Mr. & Mrs.)
	Dresser, Single
	Dresser, Vanity
	Futon(s)
	Lamp(s)
	Mirror(s)
	Night Table(s)
	Painting(s)
	Pillow(s)
	Quilt(s) / Blanket(s)
	Sheet Set(s)
	Spread(s) / Comforter(s)
	Wardrobe / Standing Closet
	Rug(s)

QTY	KITCHEN	VALUE
	Breakfast Table / Chairs
	Curtains
	Dishes
	Flatware
	Glassware
	Linens
	Pictures
	Pots / Pans
	Small Appliances
	Stool
	Towels
	Utensils / Cutlery
	Utility Cabinet
	Vegetable Bin

QTY	APPLIANCES (LARGE)	VALUE
	Air Conditioner, Window
	Dehumidifier
	Dishwasher
	Dryer, Electric / Gas
	Freezer
	Garbage Compactor
	Microwave Oven
	Range, Electric / Gas
	Refrigerator
	Washing Machine

ARTICLES OWNED
QTY	NURSERY	VALUE
	Bed, Youth
	Chair
	Chest
	Crib / Bassinet
	High Chair
	Lamp
	Play Pen
	Stroller
	Table, Childs
	Toy Chest
	Toys

QTY	PORCH / OUTDOOR EQUIPMENT	VALUE
	Barbeque
	Bird Bath
	Flower Pots
	Garden Hose(s)
	Glider
	Ladder(s)
	Lawn Chairs
	Lawn Mower / Tractor
	Outside Child's Gym
	Patio Table
	Patio Umbrella
	Picnic Bench / Table
	Rug(s)
	Sand Box
	Wheel Barrow
	Yard Tools (non-powered)
	Yard Tools (powered)

QTY	PERSONAL ITEMS	VALUE
	Eyeglasses / Sunglasses
	Perfumes / Colognes
	Razor(s)

QTY	MISCELLANEOUS	VALUE
	Alarm Clock(s)
	Basket, clothes
	Bicycle(s)
	Books
	Cabinet, File
	Camera(s) (other than video)
	Camera(s) Video
	Card Table and Chairs
	Carpet(s)
	Carriage, Baby
	Computer(s)
	Computer, Monitor(s)
	Computer, Printer(s)
	Computer UPS (battery backup)
	Desk(s)
	Fan(s)
	Folding Table
	Foot Locker(s)
	Golf Bag
	Golf Clubs