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Date of Insurance Required From
dd mm yyyy
Method of transport  
Voyage   PLEASE REFER TO THE LIST OF EXCLUDED TERRITORIES WITHIN THE CONDITIONS OF COVER
From  
To  
If your shipment comprises Household goods and Personal Effects please complete the Inventory, for shipments of Motor Vehicles please complete the Vehicle schedule.

INVENTORY
It is in your interest to make sure that your effects are insured for their full replacement value in the country of destination. If you are in any doubt you should enquire with the UK Embassy or similar representative body of the Country of destination. Values in the UK frequently vary considerably from those in other Countries. If you under insure your goods 'average' will be applied - this means you will only recover the percentage of your loss which the insured value bears to the actual value.

Example: Items value £1500 but insured for £1000, damage of £900 sustained.
{1000}
{--------- } x 900 = £600 less the policy excess (see conditions of cover)
{1500}

HOUSEHOLD GOODS
Description of goods  
Name of Professional Packer  
If you have employed a Professional Packer to pack you goods please enter the name of the packer by typing over the words 'Owner Packed'.
Number Category Value £ Maximum £
1 Carpets & Rugs  
2 Clothing, footwear and similar including fashion jewellery.  
3 Other soft goods i.e. Linen, Towels, Curtains & Cushions  
4 Jewellery and watches, (not fashion jewellery) 5000
5 Gold and Silverware 3000
6 Antiques (non furniture), that is over 100 years old 10000
7 Stamp collections, Coin collections and similar 500
8 Furniture (Antique), that is over 100 years old 5000
9 Furniture (Bedroom)  
10 Furniture (Dining Room and Lounge)  
11 Furniture (Bathroom and Kitchen)  
12 Furniture (All Other)  
13 Glassware, Chinaware, Ornaments, Clocks and Other similar Fragile Items 3000
14 Household electrical appliances - Cookers, Cleaners Washing Machines and similar.  
15 Musical Instruments 3000
16 Paintings and Pictures 5000
17 Photographic equipment, Binoculars, Microscopes and similar.  
18 Audio and Visual Equipment, Laptops, Personal and Home Computers  
19 DVD's, CD's, Records and Tapes  
20 Sewing Machines and Typewriters  
21 Cutlery and General Kitchen utensils  
22 Sports goods, Books, Toys, Prams, Bicycles, Garden equipment and Tools  
23 Suitcases, Trunks, Valises and Grips  
24 Other items not shown above 5000
25 Total Packing and Transport costs  
Total Maximum 100000   
NB The total will auto complete once the premium is requested  

MOTOR VEHICLE SCHEDULE
Description of goods  
Vehicles should be insured for their full value at destination including Freight costs. If you do not insure for full value any claim payments will be proportionately reduced as per the Average Clause, please see example above.

N.B As a guide the MINIMUM we suggest you insure for, should be the UK value plus 50% plus Freight and Packing costs.

PLEASE NOTE THAT IN RESPECT OF MOTOR VEHICLES COVER EXCLUDERS ALL PERIODS WHILST THE VEHICLE IS UNDER ITS OWN POWER OTHER THAN FOR THE PURPOSES OF LOADING ONTO OR UNLAODING FROM A CARRYING CONVEYANCE

Number    
1 Make of Vehicle
2 Model
3 Year of Manufacturer
4 Registration Number or Chassis Number
5 Value £   Maximum 50,000

Additional information
you wish to advise
Any other facts known to you which are likely to affect acceptance or assessment of the risks proposed for insurance must be disclosed. Should you have any doubt about what you should disclose, do not hesitate to tell us.
  • I declare that the statements and particulars given above are, to the best of my knowledge and belief, true and complete. I agree to accept insurance subject to the conditions of cover which I have read, that any claim shall be settled in accordance therewith and that the insurance will not be in force until the premium paid. I confirm that the shipment does not involve any countries or territories listed within the Excluded Territories Clause.
  • I confirm that I have not suffered any losses during the past 3 years arising out of the shipment of either Household goods, Personal Effects or Motor Vehicles.
  • I confirm that I have read and accept:
    The conditions of cover and details concerning the excess.
    The terms and conditions of a&b insurances brokers.
    Both the Demands and Needs and the Disclosure Document.
Please confirm that you have read and agreed to the above by checking this box
Both we and Insurers reserve the right to cancel cover and return any premium paid should it be established that any of the information provided is incorrect or incomplete.
 
Premium      Minimum £60 (Household),   £160 (Motor vehicle)
including £10 policy fee