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HOME INVENTORY

WORKSHEET

A record of your personal belongings

What if you lost all the contents of your home today? Would you remember all that you had? An inventory of your personal belongings is an important part of preparing for loss situations. In case your home is ever burglarized or damaged by fire or other causes, you can use your inventory to identify missing or damaged items. Also, a completed inventory could make it easier and faster to evaluate your claim.

A completed home inventory will give you:

• A permanent record of the contents of your home and their estimated value.

• A list of product brands and model and serial identification numbers.

• A good estimate of personal property insurance coverage you need.

Consider investing time and effort into completing your home inventory—you will be glad you did.

How to get started

The first several pages of the inventory worksheet provide space for you to list items that may be found throughout your home but that are not specific to any particular room. These categories include electronics, collectibles, jewellery, and sports equipment.

Use the remaining pages to list items as they pertain to each room in your home, such as bedroom furniture. Transfer the total at the bottom of each page to the summary on page 22. This will give you an estimated value of the contents of your home.

Photographs, videos, and lists help

As you go through your home to complete the inventory, consider taking photographs or videos of each room and the contents of cabinets and closets. You also may want to consider compiling a separate list of items you have many of, such as books, clothing, or CDs/DVDs. Being able to look at a photograph or review a video or completed list will help you determine what is missing or destroyed, and it may help us assess the value of those items.

HOME INVENTORY CHECKLIST

ELECTRICAL APPLIANCESItem Brand/Model/Serial No. Year Purch’d Estimated Value

Window Air Conditioning Unit(s)

Other

List additional contents in the extra space provided on pages 18-21.

TOTAL $_________

(Record on page 22)

2

3

ELECTRONIC EQUIPMENTItem Brand/Model/Serial No. Year Purch’d Estimated Value

Computers

Computer accessories(fax, scanners, printers, etc.)

Game systems

Stereo equipment

Television(s)

DVD and/or Blu-Ray player(s)

Wireless devices

Other

List additional contents in the extra space provided on pages 18-21.

TOTAL $_________

(Record on page 22)

HOBBIES AND COLLECTIONSItem Brand/Model/Serial No. Year Purch’d Estimated Value

Antiques

Art objects

Collections (coin, etc.)

Craft materials

Figurines

List additional contents in the extra space provided on pages 18-21.

TOTAL $_________

(Record on page 22)

4

HOBBIES AND COLLECTIONSItem Brand/Model/Serial No. Year Purch’d Estimated Value

Musical instruments

Paintings

Photography

Toys

Other

List additional contents in the extra space provided on pages 18-21.

TOTAL $_________

(Record on page 22)

5

JEWELLERY AND FURSItem Brand/Model/Serial No. Year Purch’d Estimated Value

Bracelets

Broaches

Earrings

Necklaces

Rings

Watches

Other

List additional contents in the extra space provided on pages 18-21.

TOTAL $_________

(Record on page 22)

6

SPORTS EQUIPMENTItem Brand/Model/Serial No. Year Purch’d Estimated Value

Bikes

Bowling

Fishing

Golf

Hunting

Skis

Swim/Diving gear

Tennis rackets

Other

List additional contents in the extra space provided on pages 18-21.

TOTAL $_________

(Record on page 22)

7

LIVING OR FAMILY ROOMNo. of items Item/Brand

Year Purch’d

Estimated Value

Books

Bookcases

Cabinets and contents

Chairs

Closet contents

Couch

Desk

Fireplace equipment

Knick-knacks

Lamps

Rugs

Tables

Wall shelves

List additional contents in the extra space provided on pages 18-21.List other electronic appliances/equipment on page 2 and 3.

TOTAL $_________

(Record on page 22)

8

DINING ROOMNo. of Items Item/Brand

Year Purch’d

Estimated Value

Books

Cabinets and contents

Chairs

China

Crystal

Knick-knacks

Other furniture

Rugs

Silverware/Goldware

Tables

Table linens

Wall shelves

List additional contents in the extra space provided on pages 18-21.List other electronic appliances/equipment on page 2 and 3.

TOTAL $_________

(Record on page 22)

9

KITCHENNo. of Items Item/Brand

Year Purch’d

Estimated Value

Books

Cabinets and contents

Closet contents

Crystal

Cutlery

Dishes

Dishwasher

Freezer

Glassware

Kitchen utensils

Knick-knacks

Linens

Microwave

Pots and pans

Refrigerator

Rugs

Silverware

Stove

Tables

List additional contents in the extra space provided on pages 18-21.List other electronic appliances/equipment on page 2 and 3.

TOTAL $_________

(Record on page 22)

10

MASTER BEDROOMNo. of Items Item/Brand

Year Purch’d

Estimated Value

Bedding

Beds

Books

Chairs

Chests and contents

Closet contents

Clothing

Desk

Dressers and contents

Knick-knacks

Lamps

Other furniture

Rugs

Tables

Wall shelves

List additional contents in the extra space provided on pages 18-21.List other electronic appliances/equipment on page 2 and 3.

TOTAL $_________

(Record on page 22)

11

BEDROOM 2No. of Items Item/Brand

Year Purch’d

Estimated Value

Bedding

Beds

Books

Chairs

Chests and contents

Closet contents

Clothing

Desk

Dressers and contents

Knick-knacks

Lamps

Other furniture

Rugs

Tables

Wall shelves

List additional contents in the extra space provided on pages 18-21.List other electronic appliances/equipment on page 2 and 3.

TOTAL $_________

(Record on page 22)

12

BEDROOM 3No. of Items Item/Brand

Year Purch’d

Estimated Value

Bedding

Beds

Books

Chairs

Chests and contents

Closet contents

Clothing

Desk

Dressers and contents

Knick-knacks

Lamps

Other furniture

Rugs

Tables

Wall shelves

List additional contents in the extra space provided on pages 18-21.List other electronic appliances/equipment on page 2 and 3.

TOTAL $_________

(Record on page 22)

13

BEDROOM 4No. of Items Item/Brand

Year Purch’d

Estimated Value

Bedding

Beds

Books

Chairs

Chests and contents

Closet contents

Clothing

Desk

Dressers and contents

Knick-knacks

Lamps

Other furniture

Rugs

Tables

Wall shelves

List additional contents in the extra space provided on pages 18-21.List other electronic appliances/equipment on page 2 and 3.

TOTAL $_________

(Record on page 22)

14

DEN OR OFFICENo. of Items Item/Brand

Year Purch’d

Estimated Value

Books

Bookcases

Cabinets and contents

Chairs

Closet contents

Couches

Desk

Fireplace equipment

Knick-knacks

Lamps

Other furniture

Rugs

Tables

Wall shelves

List additional contents in the extra space provided on pages 18-21.List other electronic appliances/equipment on page 2 and 3.

TOTAL $_________

(Record on page 22)

15

HALLSNo. of Items

Item Brand/Model/Serial No.

Year Purch’d

Estimated Value

Cabinets and contents

Chairs

Closet contents

Knick-knacks

Lamps

Rugs

Tables

BATHROOMS/LAUNDRY ROOM

Cabinets and contents

Closet contents

Clothes dryer

Ironing board

Linens

Lamps

Washing machine

ATTIC

Furniture

Luggage

Other storage

Trunk and contents

List additional contents in the extra space provided on pages 18-21. List other electronic appliances/equipment on page 2 and 3.

TOTAL $_________

(Record on page 22)

16

BASEMENTNo. of Items

Item Brand/Model/Serial No.

Year Purch’d

Estimated Value

Chairs

Couch

Dehumidifier

Dryer

Hand tools

Heating unit

Knick-knacks

Luggage

Other equipment

Other furniture

Other storage

Rugs

Tables

GARAGE

Auto equipment

Garden tools

Lawn furniture

Lawn games

Lawn mowers

Power and other tools

Other storage

List additional contents in the extra space provided on pages 18-21. List other electronic appliances/equipment on page 2 and 3.

TOTAL $_________

(Record on page 22)

17

18

ADDITIONAL CONTENTSNo. ofItems Item Brand/Model/Serial No.

YearPurch’d

Estimated Value

TOTAL $_________

(Record on page 22)

19

ADDITIONAL CONTENTSNo. ofItems Item Brand/Model/Serial No.

YearPurch’d

Estimated Value

TOTAL $_________

(Record on page 22)

20

ADDITIONAL CONTENTSNo. ofItems Item Brand/Model/Serial No.

YearPurch’d

Estimated Value

TOTAL $_________

(Record on page 22)

21

ADDITIONAL CONTENTSNo. ofItems Item Brand/Model/Serial No.

YearPurch’d

Estimated Value

TOTAL $_________

(Record on page 22)

22

ESTIMATED VALUE SUMMARY

Page

Total Estimated Value

2-3 Electrical Appliances,Electronic Equipment $__________

4-5 Hobbies and Collections $__________

6 Jewellery and Furs $__________

7 Sports Equipment $__________

8 Living or Family Room $__________

9 Dining Room $__________

10 Kitchen $__________

11 Master Bedroom $__________

12 Bedroom 2 $__________

13 Bedroom 3 $__________

14 Bedroom 4 $__________

15 Den or Office $__________

16 Halls, Bathrooms, Laundry Room, and Attic

$__________

17 Basement and Garage $__________

18-21 Additional Contents $__________

Overall total $__________

RECORD OF INSURANCE POLICIES

Policy Type Coverage Amount Policy Number Agent

23

What to do with your completed home inventory

Keep all home inventory related items in a safe place, preferably in a safe deposit box or a fireproof safe at home. Items include a home inventory worksheet, photos, videos, and receipts. It’s important to update your inventory when you make new purchases.

Visit with your State Farm® agent about your home inventory. Your agent can review your insurance coverages and help you protect your personal belongings against theft, fire, and other losses.

YOUR NAME:______________________________

YOUR ADDRESS:____________________________

________________________________________

________________________________________

DATE OF INVENTORY:________________________

Be aware that in the event of loss, State Farm may need more information about ownership and value.Residential policies generally include limitations on the insurance coverage available for certain classes of personal property. Review these limitations with your State Farm agent and talk about your coverage options.

State Farm branded policies are underwritten by Certas Home and Auto Insurance Company.®State Farm and related trademarks and logos are registered trademarks owned by State Farm Mutual Automobile Insurance Company, used under licence by Certas Home and Auto Insurance Company.

statefarm.ca®

SMF-50012 CN.3 02-2015

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