HOME INVENTORY FORM
An up-to-date inventory of your possessions and a record of their value will be helpful to you, your
insurer and others, in case of fire or burglary. It will also help you to determine if you have the proper
insurance coverage you need. Take the time to complete this form and keep it in a safe place. (Pictures
can help too)
Date Completed:
LIVING ROOM
KITCHEN
ARTICLE
REPLACEMENT COST
ARTICLE
Step - Stool
Chesterfield
Table
Chair(s)
Dinette Set
Lamp(s)
Electric Appliances
Table(s)
Dishes
Rug(s), Carpet(s)
Cutlery
Bric-a-Brac
Utensils
Clock(s)
Pots & Pans
Paintings, Pictures
Bowls etc
Curtains, Drapes
Food Stuffs
Pianos or other instruments
REPLACEMENT COST
Stove
Refrigerator
Dishwasher
Microwave
Garburetor
TOTAL
Home Inventory
$0.00 TOTAL
$0.00
Page 1 of 7
DINING ROOM
FAMILY REC ROOM
ARTICLE
REPLACEMENT COST
ARTICLE
Chesterfield
Table(s)
Chair(s)
Chair(s)
Lamp(s)
China Cabinet
Table(s)
Buffet
Rug(s), Carpet(s)
Serving Table
Bric-a-Brac
Rug(s), Carpets(s)
Paintings, Pictures
Curtains, Drapes
REPLACEMENT COST
Curtains, Drapes
CDs, DVDs, Tapes
TOTAL
$0.00 TOTAL
VERANDA or PATIO
BATHROOM 1
ARTICLE
$0.00
REPLACEMENT COST
ARTICLE
Floor Mat(s)
Table(s)
Curtains
Chair(s)
Bric-a-Brac
Sofa(s)
Electric Appliances
Glider
REPLACEMENT COST
Outdoor Cooking Equipment
BBQ
TOTAL
Home Inventory
$0.00 TOTAL
$0.00
Page 2 of 7
ELECTRONICS
ARTICLE
BRAND/MODEL
SERIAL NO.
REPLACEMENT COST
Television
Stereo
CD player
DVD player
VCR
Computer
Printer
iPod/MP3 player
Cell phone
Home Theatre
TOTAL
Home Inventory
$0.00
Page 3 of 7
BEDROOMS
1
2
4
3
REPLACEMENT COST
ARTICLE
Chair(s)
Bed(s)
Bedding
Night Table(s)
Dressing Table(s)
Bench
Chest of Drawers(s)
Mirror(s)
Rug(s)
Lamp(s)
Bric-A-Brac
Clock(s)
Curtains, Drapes
$0.00
TOTAL
$0.00
REPLACEMENT COST
ARTICLE
Floor Mat(s)
Floor Mat(s)
Curtains
Curtains
Bric-a-Brac
Bric-a-Brac
Electric Appliances
Electric Appliances
TOTAL
Home Inventory
$0.00
BATHROOM 3
BATHROOM 2
ARTICLE
$0.00
$0.00 TOTAL
REPLACEMENT COST
$0.00
Page 4 of 7
CHINA, CRYSTAL
CLOTHING AND LINENS
ARTICLE
REPLACEMENT COST
ARTICLE
REPLACEMENT COST
Coats
Raincoats
Jackets
Suits
Dresses
Sports Coats
Shirts
Slacks
Sweaters
Blouses
Skirts
Belts
Socks & Hosiery
TOTAL
$0.00
SILVER , JEWELLERY, FURS, STAMPS AND COIN
COLLECTIONS
(Check with your Agent/Broker for limits in present policy)
Ties
Underwear
Lingerie
Sleepwear
Shoes
Boots
Slippers
Sandals
Handbags
Sheets & Pillowcases
Spreads
Blankets, Comforters
Towels
TOTAL
Home Inventory
$0.00 TOTAL
$0.00
Page 5 of 7
MISCELLANEOUS
BASEMENT, GARAGE
ARTICLE
REPLACEMENT COST
ARTICLE
Work Bench
Sports Equipment
Tools
Book(s)
Snow Blower
Christmas Decorations
Lawn Mower
Hobby Equipment
Garden Tools
Woodworking Machinery
Furniture
House Plants
Luggage
Pool Equipment
Washing Machine
Air Conditioner
Clothes Dryer
Bicycle(s)
REPLACEMENT COST
Freezer
Freeezer Contents
Games, Toys etc
TOTAL
$0.00 TOTAL
OTHER ROOMS
OTHER ROOMS
ARTICLE
TOTAL
Home Inventory
$0.00
REPLACEMENT COST
ARTICLE
$0.00 TOTAL
REPLACEMENT COST
$0.00
Page 6 of 7
SUMMARY
KITCHEN
$0.00
FAMILY/REC ROOM
$0.00
LIVING ROOM
$0.00
DINING ROOM
$0.00
BEDROOM 1
$0.00
BEDROOM 2
$0.00
BEDROOM 3
$0.00
BEDROOM 4
$0.00
BATHROOM 1
$0.00
BATHROOM 2
$0.00
VERANDA OR PATIO
$0.00
OTHER ROOM
$0.00
OTHER ROOM
$0.00
BASEMENT/GARAGE
$0.00
MISCELLANEOUS
$0.00
CLOTHING & LINEN
$0.00
CHINA & CRYSTAL
$0.00
SILVER, JEWELLERY ETC
$0.00
ELECTRONICS
$0.00
BATHROOM 3
OTHER
$0.00
$0.00
$0.00
GRAND TOTAL
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Home Inventory
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