
You can print this form and store for your
records.
| Quantity | Item | Date Purchased | Purchase Cost | Replacement Cost |
| ______ | Cabinet / Contents | ____________ | ____________ | ____________ |
| ______ | Chairs | ____________ | ____________ | ____________ |
| ______ | Cleaning Appliances | ____________ | ____________ | ____________ |
| ______ | Clocks | ____________ | ____________ | ____________ |
| ______ | Cupboards / Contents | ____________ | ____________ | ____________ |
| ______ | Curtains/Drapes/Blinds | ____________ | ____________ | ____________ |
| ______ | Dishes | ____________ | ____________ | ____________ |
| ______ | Dishwasher | ____________ | ____________ | ____________ |
| ______ | Floor covering | ____________ | ____________ | ____________ |
| ______ | Food | ____________ | ____________ | ____________ |
| ______ | Freezer | ____________ | ____________ | ____________ |
| ______ | Fridge | ____________ | ____________ | ____________ |
| ______ | Paintings, etc. | ____________ | ____________ | ____________ |
| ______ | Pots/ Pans | ____________ | ____________ | ____________ |
| ______ | Radio | ____________ | ____________ | ____________ |
| ______ | Small Appliances | ____________ | ____________ | ____________ |
| ______ | Tables | ____________ | ____________ | ____________ |
| TOTAL | ____________ | |||