Home Inventory

Introduction

Policy number

Coverage

Deductible

Expiry date

Contacts

Your Grey Power Broker 1-855-257-2525

24/7 Emergency Claims 1-855-256-2525

Overview

Total replacement cost by room*

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

Minimum Contents Coverage Needed $ -

Living Room

Dining Room

Kitchen

Family Room or Rec Room

Entryway and Hallway

Master Bathroom

Bathroom A

Bathroom B

Master Bedroom

Basement, Storage and Garage

Other Bedroom A

Other Bedroom B

Office

Valuables

*This is a non-exhaustive contents list. Your actual list may vary. Please refer to the terms and conditions of your policy for details on any limitations, restrictions and exclusions that may apply.

*This is a non-exhaustive contents list. Your actual list may vary. Please refer to the terms and conditions of your policy for details on any limitations, restrictions and exclusions that may apply.

Home Inventory

Master Bedroom

Number of Items Description Serial/Model No.

Bedding and pillows $0.00Bedroom furniture $0.00Books $0.00Carpets and rugs $0.00Clothing Business and other suits $0.00 Coats $0.00 Dresses $0.00 Hats $0.00 Jackets $0.00 Pants $0.00 Purses and handbags $0.00 Scarves $0.00 Shirts and blouses $0.00 Shoes and boots $0.00 Skirts $0.00 Ties $0.00 Various accessories $0.00Curtains, draperies and blinds $0.00

$0.00Duvet and/or comforter $0.00Fan $0.00Flooring $0.00Humidifier $0.00Lamps and lighting fixtures $0.00Paintings and prints $0.00Stereo system and/or clock radio $0.00Television $0.00VCR, DVD player $0.00Other

$0.00$0.00$0.00$0.00$0.00$0.00

TOTAL $0.00

Replacement Cost

Decorative items (wall hangings, figurines, etc.)

When entering replacement cost values, indicate the cost to replace the item with new articles of similar kind and quality.

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Home Inventory

Living RoomNumber of Items Description Serial/Model No.

Audiotapes 0.00Books 0.00Bookshelves and other shelves 0.00Cabinets 0.00Camcorder (video camera) 0.00Camera 0.00Carpets and rugs 0.00CDs, records 0.00Chairs 0.00Curtains, draperies and blinds 0.00Flooring 0.00Home theatre system

DVDs 0.00Satellite or digital receiver 0.00Speakers 0.00Television or screen 0.00VCR, DVD player 0.00Video cassettes 0.00

0.00Video games 0.00

Lamps and lighting fixtures 0.00Mirrors 0.00Musical instruments 0.00Paintings and prints 0.00Radio 0.00Sofas 0.00Stereo system 0.00Tables 0.00Telephone 0.00Other

0.000.000.000.000.000.00

TOTAL 0.00

Replacement Cost

Video game console and accessories

When entering replacement cost values, indicate the cost to replace the item with new articles of similar kind and quality.

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Home Inventory

Dining RoomNumber of Items Description Serial/Model No.

Buffet/sideboard $0.00Carpets and rugs $0.00Chairs $0.00China and other cabinets $0.00China tableware and other dishes $0.00Crystal and other glassware $0.00Curtains, draperies and blinds $0.00Cutlery 0.00

$0.00Flooring $0.00Lighting fixtures $0.00Mirrors $0.00Paintings and prints $0.00Shelves $0.00Table $0.00Table linens $0.00Other

$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00

0.00$0.00

Total $0.00

Replacement Cost

Decorative items (wall hangings, figurines, etc.)

When entering replacement cost values, indicate the cost to replace the item with new articles of similar kind and quality. Back

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Home Inventory

Entryway and HallwayNumber of Items Description Serial/Model No.

Alarm system 0.00Boots 0.00Cabinets 0.00Carpets and rugs 0.00Chairs and benches 0.00Coats 0.00

0.00

Flooring 0.00Home control system 0.00Intercom 0.00Mirrors 0.00Shoes 0.00Tables 0.00Vacuum cleaner 0.00Other

0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00

TOTAL 0.00

Replacement Cost

Decorative items (wall hangings, figurines, etc.)

When entering replacement cost values, indicate the cost to replace the item with new articles of similar kind and quality.

Back

Back

Home Inventory

KitchenNumber of Items Description Serial/Model No.

Cabinets and countertops 0.00Chairs and stools 0.00Clock 0.00Coffee maker 0.00Curtains, draperies and blinds 0.00

0.00Dishes 0.00Dishwasher 0.00Flooring 0.00

0.00

0.00Freezer 0.00Kitchen linens 0.00Lamps and lighting fixtures 0.00Microwave 0.00OvenPots and pans 0.00Radio 0.00Range hood 0.00Refrigerator 0.00Stovetop 0.00Table 0.00Television 0.00Toaster 0.00Utensils 0.00Water cooler 0.00Other 0.00

0.000.000.000.000.000.000.000.000.00

TOTAL 0.00

Replacement Cost

Decorative items (wall hangings, figurines, etc.)

Food in cupboards and refrigerator

Food processor, ice-cream maker, other small appliances

When entering replacement cost values, indicate the cost to replace the item with new articles of similar kind and quality.

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Back

Home Inventory

Family Room or Rec RoomNumber of Items Description Serial/Model No.

Audiotapes 0.00Books 0.00Bookshelves and other shelves 0.00Cabinets 0.00Carpets and rugs 0.00CDs, records 0.00Chairs 0.00Curtains, draperies and blinds 0.00

0.00Fireplace accessories 0.00

0.00FlooringFramed pictures 0.00Home theatre system

DVDs 0.00Satellite or digital receiver 0.00Speakers 0.00Television or screen 0.00VCR, DVD player 0.00Video cassettes 0.00

0.00Video games 0.00

Lamps and lighting fixtures 0.00Mirrors 0.00Musical instruments 0.00Paintings and prints 0.00Radio 0.00Sofas 0.00Stereo system 0.00Toys 0.00Other

0.000.000.000.000.00

TOTAL 0.00

Replacement Cost

Decorative items (wall hangings, figurines, etc.)

Fitness equipment (weights, benches, mats, etc.)

Video game console and accessories

When entering replacement cost values, indicate the cost to replace the item with new articles of similar kind and quality. Back

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Home Inventory

Master BathroomNumber of Items Description Serial/Model No.

Bathtub 0.00Cabinets and countertops 0.00Cosmetics 0.00Curtains, draperies and blinds 0.00

0.00

0.00

Flooring 0.00

Paintings and prints 0.00Perfumes 0.00Medication(s) 0.00Mirrors 0.00Rugs and carpets 0.00Scale 0.00Shelves 0.00Shower stall 0.00Sink(s) 0.00Toilet 0.00Toiletries 0.00Towels and face cloths 0.00Other

0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00

TOTAL 0.00

Replacement Cost

Decorative items (wall hangings, figurines, etc.)

Electrical appliances (hair dryer, rasor, etc.)

When entering replacement cost values, indicate the cost to replace the item with new articles of similar kind and quality.

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Home Inventory

Bathroom ANumber of Items Description Serial/Model No.

Bathtub 0.00Cabinets and countertops 0.00Cosmetics 0.00Curtains, draperies and blinds 0.00

0.00

0.00

Flooring 0.00

Paintings and prints 0.00Perfumes 0.00Medication(s) 0.00Mirrors 0.00Rugs and carpets 0.00Scale 0.00Shelves 0.00Shower stall 0.00Sink(s) 0.00Toilet 0.00Toiletries 0.00Towels and face cloths 0.00Other 0.00

0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00

TOTAL 0.00

Replacement Cost

Decorative items (wall hangings, figurines, etc.)

Electrical appliances (hair dryer, rasor, etc.)

When entering replacement cost values, indicate the cost to replace the item with new articles of similar kind and quality.

Back

Back

Home Inventory

Bathroom BNumber of Items Description Serial/Model No.

Bathtub 0.00Cabinets and countertops 0.00Cosmetics 0.00Curtains, draperies and blinds 0.00

0.00

0.00

Flooring 0.00

Paintings and prints 0.00Perfumes 0.00Medication(s) 0.00Mirrors 0.00Rugs and carpets 0.00Scale 0.00Shelves 0.00Shower stall 0.00Sink(s) 0.00Toilet 0.00Toiletries 0.00Towels and face cloths 0.00Other 0.00

0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00

TOTAL 0.00

Replacement Cost

Decorative items (wall hangings, figurines, etc.)

Electrical appliances (hair dryer, rasor, etc.)

When entering replacement cost values, indicate the cost to replace the item with new articles of similar kind and quality.

Back

Back

Home Inventory

Basement, Storage and GarageNumber of Items Description Serial/Model No.

Air conditioner 0.00Air purifier 0.00Automobile accessories 0.00Barbecue 0.00Bicycles 0.00Cabinets and countertops 0.00Camping equipment 0.00Cleaning supplies 0.00Deep freeze 0.00Dehumidifier 0.00Dryer 0.00Power tools 0.00Furnace 0.00Gardening tools 0.00Hand tools 0.00Hot water heater 0.00Lawn mower 0.00Luggage 0.00Outdoor furniture 0.00Seasonal clothing 0.00Seasonal decorations 0.00Sewing machine 0.00Shelves 0.00Snow blower 0.00

0.00Washing machine 0.00Workbench 0.00Other 0.00

0.000.000.000.000.000.000.000.00

TOTAL 0.00

Replacement Cost

Sports equipment (golf clubs, skis, etc.)

When entering replacement cost values, indicate the cost to replace the item with new articles of similar kind and quality.

Back

Back

Home Inventory

Bedroom ANumber of Items Description Serial/Model No.

Bedding and pillows 0.00Bedroom furniture 0.00Books 0.00Bookshelves and other shelves 0.00Clothing Business and other suits 0.00 Children's wear 0.00 Coats 0.00 Dresses 0.00 Hats 0.00 Pants 0.00 \ Purses and handbags 0.00 Scarves 0.00 Shirts and blouses 0.00 Shoes & boots 0.00 Skirts 0.00

0.00 Various accessories 0.00Curtains, draperies and blinds 0.00

0.00Duvet and/or comforter 0.00Fan 0.00FlooringHumidifier 0.00Lamps and lighting fixtures 0.00Paintings and prints 0.00Stereo system and/or clock radio 0.00Television 0.00Toys 0.00VCR, DVD player 0.00Other

0.000.000.000.000.000.000.00

TOTAL 0.00

Replacement Cost

Ties

Decorative items (wall hangings, figurines, etc.)

When entering replacement cost values, indicate the cost to replace the item with new articles of similar kind and quality.

Back

Back

Home Inventory

Bedroom BNumber of Items Description Serial/Model No.

Bedding and pillows 0.00Bedroom furniture 0.00Books 0.00Bookshelves and other shelves 0.00Clothing Business and other suits 0.00 Children's wear 0.00 Coats 0.00 Dresses 0.00 Hats 0.00 Pants 0.00 \ Purses and handbags 0.00 Scarves 0.00 Shirts and blouses 0.00 Shoes & boots 0.00 Skirts 0.00

0.00 Various accessories 0.00Curtains, draperies and blinds 0.00

0.00Duvet and/or comforter 0.00Fan 0.00FlooringHumidifier 0.00Lamps and lighting fixtures 0.00Paintings and prints 0.00Stereo system and/or clock radio 0.00Television 0.00Toys 0.00VCR, DVD player 0.00Other

0.000.000.000.000.000.000.00

TOTAL 0.00

Replacement Cost

Ties

Decorative items (wall hangings, figurines, etc.)

When entering replacement cost values, indicate the cost to replace the item with new articles of similar kind and quality.

Back

Back

Home Inventory

OfficeNumber of Items Description Serial/Model No.

Books 0.00Bookshelves and other shelves 0.00Briefcase(s) and laptop bags 0.00Calculator 0.00Carpets and rugs 0.00CD-ROMs 0.00Cellphone(s) 0.00Clock 0.00Computer 0.00Fax machine 0.00Filing cabinets 0.00Flooring 0.00Furniture 0.00Label maker 0.00Office supplies 0.00Pager(s) 0.00Paintings and prints 0.00PDA(s) (handheld computers) 0.00

0.00Photocopier 0.00Radio 0.00Software 0.00Telephone 0.00Television 0.00VCR, DVD player 0.00Other

0.000.000.000.000.000.000.000.000.000.00

TOTAL 0.00

Replacement Cost

Peripherals (printer, scanner, external hard drives, etc.)

When entering replacement cost values, indicate the cost to replace the item with new articles of similar kind and quality.

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Home Inventory

ValuablesNumber of Items Description Serial/Model No.

0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00

TOTAL 0.00

Replacement Cost

Use this space to record the items you did not include in the room-by-room inventory

(e.g., jewellery, furs, artwork, collectibles, etc.).

When entering replacement cost values, indicate the cost to replace the item with new articles of similar kind and quality.

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