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          CONTACT INFORMATION                                           Thank you.

* Contact Name                             اسم المتصل
* Email                                        البريد الإلكتروني

 Please complete as fully as possible  boxes where applicable.
1. Dining room Value (JD)   Value (JD)
Furniture Pictures/paintings Quantity
Carpets/rugs Quantity Curtains
Silverware and plates Pictures/paintings Quantity
2. Living room/study Value (JD)   Value (JD)
Furniture Carpets/rugs Quantity
Curtains Pictures/paintings Quantity
3. Bedrooms Value (JD)   Value (JD)
Furniture Beds Quantity
Carpets/rugs Quantity Curtains
4. Kitchen Value (JD)   Value (JD)
Furniture Cutlery
Utensils/pots/pans  
5. Electrical Value(JD)   Value (JD)
Refrigerator Freezer
Microwave Cooker
Vacuum cleaner Radios    
TV sets Quantity Video recorder
Stereo components Quantity Washing   machine
Spin/tumble dryer Dishwasher
Food processor Sewing machine
Computer equipment Quantity Lamps/shades
Other electrical goods
6. Clothing and linen Value (JD)   Value (JD)
Men’s clothing Ladies' clothing
Children’s clothing Shoes
Towels/linen Bedding
Cushions  
7. Fragiles Value (JD)   Value (JD)
China  sets   Quantity Glassware
Crystal Earthenware
Ornaments Mirrors
8. Miscellaneous Value (JD)   Value (JD)
Photographic equipment Sports equipment
Garden tools Lawnmower
Garden furniture Tools
Musical instruments Piano/organ
Trunks/suitcases Wines/spirits
Toys and games Books
Tapes/records/CDs Quantity Bicycles
Cosmetics  
9. Other goods, cash, bonds, etc. Value (JD)   Value(JD)
Item Value (JD) Item Value (JD)
10. LIST Of Jewellery & Furs
Item Value (JD) Item Value (JD)
11. Motor Vehicle
Make: Model:
Registration NO. : Year:
Value:
TOTAL SUM INSURED:     

 

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