1. INVENTORY NO (OPTIONAL): This is for long-distance, or storage moves, or any move where an inventory list was prepared by the movers. You must provide the corresponding inventory item number for each item claimed. This number may be found on your Household goods Descriptive inventory form to the left of each item or on the sticker affixed to the item or its packing box. 2. ITEM NAME: Indicate color, material & type of item (Ex. “Black Leather Sofa” or White Press wood Dresser”). For electronic items, appliances, musical instruments, autos, or motorcycles, you must provide the make, model number & serial number, along with a copy of the owner’s manual for these items. 3. DESCRIPTION OF DAMAGE/LOSS: For missing or lost items, indicate “missing”, for damaged items, describe damage clearly (ex: "Wall unit chipped on front of the left door & handle missing”). 4. ITEM PACKED BY (MOVERS/CLIENT): Indicate “CP” if the item was packed/wrapped by movers. Indicate “PBO” if items were packed/wrapped by you. If the item was not wrapped, indicate this & at whose request this was done. 5. WEIGHT OF ITEM: you must provide the approximate weight of each item claimed. For customers who have coverage by weight, your claim cannot be reviewed or settled without this information. You may estimate weights for purposes of this claim, and we will adjust if necessary. 6. ORIGINAL PURCHASE DATE/COST: You must provide the original date of purchase (month / Year) and original purchase cost for each item claimed. Please complete this even if you have been asked to include copies of the purchase receipts. 7. AMOUNT CLAIMED NOW: This is the amount you are claiming for each item in accordance with the valuation coverage you chose for your move. YOUR CLAIM IS NOT LEGALLY FILED AND WILL BE PERMANENTLY DENIED IF A SPECIFIC DOLLAR AMOUNT IS NOT INCLUDED FOR EACH ITEM CLAIMED. *** For customers with coverage by weight, please multiply the weight of each item claimed times the rate stated in your Bill of Lading as well as your Order for Service. *** For customers with additional valuation coverage, indicate the repair amount sought for damaged items, or the cost for missing parts. For mirror or glass, indicate the cost to replace the mirror or glass only. For missing items or those which are a total loss, indicate the depreciated value.