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Please
print, complete, sign and fax back to UK Tel: +44 (0) 117 9822229
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Agency (Block letters)
1ST MOVE INTERNATIONAL LIMITED.
Agency Ref
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Policy
Number
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IMPORTANT - PLEASE COMPLETE
IN BLOCK LETTERS AND GIVE DEFINITE ANSWERS TO EACH QUESTION
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Full Name of
Proposer (You the customer)
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Full name of
receiver overseas (If
different)
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UK
Address
Postcode
UK
Tel. Number |
Overseas
Address
Postcode
Overseas Tel Number. |
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Please note that when
completing your insurance values, the correct value for each item insured
is listed. Failure to give the correct value in this proposal will result
in the Underwriters applying an average percentage to the value, if your
goods are underinsured. For example: if an item of furniture is listed as
£500 when in fact it is worth £1,000 and your claim is for £1,000 then the
Underwriters will average out your claim due to underinsurance, and the
difference can be significant. |
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DECLARATION
I
declare that the details herein are correct according to the best of my
knowledge and belief,
and agree that the particulars and statements given shall form the basis
of the contract
between us. I agree that every item requiring insurance is listed
overleaf with the correct
quantities and values listed. I further agree that if correct values are
not listed and my effects
have been underinsured, I acknowledge that any claim will have an average
applied.
I declare that I have read and understood all conditions contained within
this proposal.
I understand that any owner packed items will be covered for loss and
theft only and the policy
does not include breakage, etc as per the Owner Packed clause contained
within this proposal. |
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Proposer / Customer
Signature |
Date
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N.B. All material facts must
be disclosed. Failure to do so could invalidate the Policy. A material fact is
one that would be likely to influence an Underwriter in the assessment and
acceptance of the proposal.
If in any doubt as to whether a fact is material
then it should be disclosed. You should keep a record (including copies of
letters) of all information supplied to Underwriters for the purpose of entering
into the contract. A copy of the completed proposal form will be supplied by
Underwriters on request within three months of completion of the proposal.
Please print,
complete, sign and fax back to
UK
Tel: +44 (0) 117 9822229
INVENTORY OF HOUSEHOLD
GOODS/PERSONAL EFFECTS (NON-ACCOMPANIED)
(This inventory will form
part of the Policy when issued)
All property should be
insured for its full replacement value at destination. Failure to do so will
result in claims being reduced proportionally. Any antique articles must be
separately declared and valued, and are subject to special rates to be agreed.
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Item Description |
Qty
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Value each
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Total Value
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Please see
Example below to ensure form is completed correctly: |
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Sofas |
2 |
£500 |
£1,000 |
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Dining Chairs |
4 |
£25 |
£100 |
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CD's |
50 |
N/A |
£500 |
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DVD's |
10 |
N/A |
£100 |
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Clothing |
Various |
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£500 |
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Please Complete,
following example above, listing
every
item requiring insurance: |
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Carried
forward to continuation sheet |
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Total Value Insured
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£ |
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Please print,
complete, sign and fax back to UK Tel: +44 (0)
117 9822229
INVENTORY OF HOUSEHOLD
GOODS/PERSONAL EFFECTS (NON-ACCOMPANIED)
(This inventory will form
part of the Policy when issued)
All property should be
insured for its full replacement value at destination. Failure to do so will
result in claims being reduced proportionally. Any antique articles must be
separately declared and valued, and are subject to special rates to be agreed.
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Item Description |
Qty
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Value each
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Total Value
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Please see the
example on form above to ensure this form is completed correctly: |
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Brought Forward from previous sheet |
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