Personal Property Inventory Form

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Personal Property Inventory Form
Claim Number____________________
Date of Loss____________________
TO BE COMPLETED BY INSURED
TO BE COMPLETED BY CLAIM REPRESENTATIVE
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Today's
Mfr/Brand Name
Purchased
Docu- Date of Purchase Value/
Quantity Description of Property
and
or
menta- Purchase
Price
Actual
Serial Model Numbe Obtained From tion
r
or Age
Cash
Value
The above information is true to the best of my knowledge.
Insured's Signature________________________________________ Date_________ Page____ of ___ Date completed_____ /_____ /___ By______________
_
_
_
_
Personal Property Inventory Form
Claim Number____________________
Date of Loss____________________
TO BE COMPLETED BY INSURED
TO BE COMPLETED BY CLAIM REPRESENTATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Today's
Mfr/Brand Name
Purchased
Docu- Date of Purchase Value/
Quantity Description of Property
and
or
menta- Purchase
Price
Actual
Serial Model Numbe Obtained From tion
r
or Age
Cash
Value
The above information is true to the best of my knowledge.
Insured's Signature________________________________________ Date_________ Page____ of ___ Date completed_____ /_____ /___ By______________
_
_
_
_

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