Enrolment Form for All Risk Protection Coverage
(For International, Local Move & Storage Shipments)   
Mr.  Mrs.  Ms.  Miss  Dr.
*First Name: *Last Name:
Professionally Packed  Owner Packed Moving By: Land  Sea  Air
Date Packed: (YYYY-MM-DD) From - - To - -
*Moving From: (City)
*Moving To: (City)


"Item By Item" Protection Coverage
Please use the list in this form to value all items included in your shipment.

Please make sure you read through the below instructions:
  1. Please declare the replacement cost at destination of all items in your shipment. Note: Every item that you intend to move must be included in the cover.
  2. Do not include cash, watches, stamps or similar valuable articles, wine & liquors as these items are excluded from the protection cover.
  3. Please ensure that any item valued individually at more than USD1,500 (or equivalent in other currencies) is listed separately.

Currency: USD  Other 
LIVING ROOM
QtyArticleValue
SOFA(s)
CHAIR(s)
LAMP(s)
TABLE(s)
RUG(s) & CARPET(s)
BOOKCASE(s)/ WALL UNIT(s)
CURTAIN(s) & BLIND(s)
PICTURE(s) & PAINTING(s)
PIANO(s) OR OTHER(s)
MUSICAL INSTRUMENT(s)
TV(s)
VIDEO RECORDER(s)
RADIO(s)
HI-FI SYSTEM(s)
RECORD PLAYER(s)
CD PLAYER(s)
DVD PLAYER(s)
SPEAKER(s)
CLOCK(s)
Sub-Total:

DINING ROOM
QtyArticleValue
TABLE(s)
CHAIR(s)
CHINA CABINET(s)
BUFFET/ SIDEBOARD(s)
HOSTESS TROLLEY(s)
LAMP(s)
RUG(s) & CARPET(s)
CURTAIN(s) & BLIND(s)
MIRROR(s)
TABLE LINEN(s)
PICTURE(s) & PAINTING(s)
WRITING BUREAU(s)/ DESK(s)
CLOCK(s)
Sub-Total:

CHINAWARE
QtyArticleValue
Sub-Total:

CRYSTAL/GLASSWARE
QtyArticleValue
Sub-Total:

SILVERWARE
QtyArticleValue
Sub-Total:

ORNAMENTS/WORKS OF ART
QtyArticleValue
Sub-Total:

ANTIQUES
QtyArticleValue
Sub-Total:

SPORTS EQUIPMENT
QtyArticleValue
Sub-Total:

BATHROOM(s)
QtyArticleValue
TOILETRIE(s)
MEDICAL SUPPLY(ies)
PERFUME(s)/ AFTERSHAVE(s)
RUG(s), TOILET COVER(s)
TOWEL(s)
LAUNDRY BASKET(s)
RAZOR(s)
HAIRDRYER(s)
CABINET/ SHELVE(s)
MIRROR(s)
Sub-Total:

BASEMENT & GAMES
QtyArticleValue
WORKBENCH(es)
TOOL BOX(es)
HAND TOOL(s)
POWER TOOL(s)
LAMN MOVER(s)
GARDEN TOOL(s)
PLANT HOLDER(s)
FURNITURE (PATIO)(s)
LUGGAGE/ TRUNK(s)
BBQ(s)
BICYCLE(s)
ARTIFICIAL TREE(s)
Sub-Total:

FAMILY ROOM/STUDY
QtyArticleValue
CHAIR(s)
CURTAIN(s) & BLIND(s)
SOFA(s)
TABLE(s)
LAMP(s)
RUG(s) & CARPET(s)
DESK(s)
BOOKCASE(s)
PICTURE(s) & PAINTING(s)
Sub-Total:

KITCHEN
QtyArticleValue
TABLE(s)
CHAIR(s)
ELECTRICAL APPLIANCE(s)
LINEN(s)
UTENSIL(s)/ CUTLERY(s)
POT(s) & PAN(s)
OVEN(s)
MICROWAVE OVEN(s)
DISHWASHER(s)
REFRIGERATOR(s)
FREEZER(s)
WASHING MACHINE(s)
TUMBLE DRYER(s)
IRON/ IRONING BOARD(s)
RUBBISH/ GARBAGE BIN(s)
FOOD (non perishable)
Sub-Total:

LINEN/CLOTHING
QtyArticleValue
BED LINEN(s)/ SHEET(s)
TABLE LINEN(s)
BLANKET(s)/ QUILT(s)
PILLOW(s)/ PILLOW CASE(s)
SPREAD(s)
COAT(s)/ JACKET(s)
SUIT(s)
DRESS(es)
SKIRT(s)
BLOUSE(s)
SHIRT(s)
TROUSER(s)/ SLACK(s)
SWEATER(s)
SPORTWEAR
NIGHTWEAR
TIE(s)/ SCARVE(s)
FOOTWEAR(s)/ SHOE(s)
HOSIERY(s)/ SOCK(s)
UNDERWEAR
HANDBAG(s)
LEATHER/ SUEDE CLOTHING
OTHER(s)
Sub-Total:

BEDROOM (MAIN)
QtyArticleValue
BED(s)
CHAIR(s)
BEDSIDE TABLE(s)
DRESSING TABLE(s)
CHEST OF DRAWERS
MIRROR(s)
RUG(s)
LAMP(s)
CURTAIN(s) & BLIND(s)
BOOKCASE(s)
WARDROBE(s)/ ARMOIRE(s)
Sub-Total:

BEDROOM(s) (OTHERS)
QtyArticleValue
BED(s)
CHAIR(s)
BEDSIDE TABLE(s)
DRESSING TABLE(s)
CHEST OF DRAWERS
MIRROR(s)
RUG(s)
LAMP(s)
CURTAIN(s) & BLIND(s)
BOOKCASE(s)
WARDROBE(s)/ ARMOIRE(s)
Sub-Total:

MISCELLANEOUS
QtyArticleValue
TYPEWRITER(s)
CLOCK(s)
TELEPHONE(s)/ FAX(s)
COMPUTER(s)
COMPUTER PRINTER(s)
COMPUTER SUPPLY(ies)
VIDEO CAMERA(s)
CAMERA(s)/ LEN(s)
MISC. CAMERA EQUIPMENT
PROJECTOR(s)
RECORD(s)
TAPE(s)
CD(s)
DVD(s)
VIDEO TAPE(s)
SEWING MACHINE(s)
FIREPLACE EQUIPMENT
TOY(s) & GAME(s)
XMAS TREE(s)/ DECORATION(s)
Sub-Total:

AUTOMOBILES
ArticleValue
YEAR (Reg No.)
MODEL
CHASSIS NUMBER
COVERED VALUE
NON FACTORY-INSTALLED AUTO ACCESSORIES MUST BE SEPARATELY LISTED AND VALUED VALUE
Sub-Total:

ADDITIONAL ITEMS Number of Lines Add  Delete
 QtyRoomArticleValue
1
2
Sub-Total:



Grand Total:
*Please select a Santa Fe office you want to submit to: 
I want to have a copy of my enrolment form.  Yes  No
If yes, please specify e-mail:  
Note: Forms submitted online cannot be retrieved via our website.
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Declaration of the Proposer
I declare that I have disclosed all material facts and understand that failure to do so could render my enrolment and coverage void. I declare that the amounts stated above are the full value of the goods at destination. I confirm that I have declared all items that I wish to be covered with all details requested. I have read the conditions stated overleaf and understand that these shall form the basis of my enrolment in the All Risk Protection Group Policy.

Arbitration
All disputes hereunder the All Risk Protection Group Policy shall be resolved in binding arbitration before the American Arbitration Association at Los Angeles, California and no other place.


TERMS AND CONDITIONS

TERMS AND CONDITIONS

 

CAUTION: BE SURE YOU READ AND UNDERSTAND IT AND COMPLY WITH ALL TERMS AND CONDITIONS. FAILURE TO COMPLY WITH ANY OF THE TERMS AND CONDITIONS MAY RESULT IN REDUCTION OF THE RECOVERABLE AMOUNT OR COULD INVALIDATE YOUR COVERAGE UNDER OUR ALL RISK PROTECTION GROUP POLICY ENTIRELY.

 

 

1.   PROPERTY COVERED: Household Goods and Personal Effects, Antiques, Fine Arts, Automobiles, Boats, Motorcycles, Campers and Trailers as declared and valued on this and supporting Documents.

2.   SCOPE OF COVER: Always subject to the due premium having been paid and the funds collected and subject to all terms and conditions of the All Risk Protection Group Policy - new and/or used household goods and personal effects, under deck, are covered against ALL RISK of direct physical loss or damage from any external cause, irrespective of percentage (Current American Institute Cargo Clauses, including "War Risk" Insurance and S.R. & C.C.Endorsement Warehouse to Warehouse Transit Clauses and Marine Extension clauses), including General Average and Salvage Charges, and transshipment, if involved.  Shipments on deck and subject to an "On Deck" Bill of Lading are covered for FPA coverage only.  Containerized shipments on deck are covered per under deck "All Risk" clauses.

3.   METHOD OF TRANSIT: Per approved vessel and/or steamer and/or air carrier and/or held covered and/or conveyances. Date of dispatch to be declared as soon as practicable to Insurer of the All Risk Protection Group Policy or its representative with the following details: name of vessel, voyage number, date of sailing and/or date of arrival.

4.   FREIGHT FORWARDER NOT INSURANCE AGENT: Santa Fe is the owner of the All Risk Protection Group Policy, and is not an agent of the Underwriters of the policy.  There is no separate policy between the covered person and the Underwriters.  Santa Fe is not authorized to make any representation what so ever concerning coverage under the All Risk Protection Group Policy. All questions concerning coverage shall be directed exclusively to the lead Underwriter, Fortis Corporate Insurance N.V., or the administrator of the policy,  Pac Global Insurance Brokerage, Inc.

5.   R.A.C.E. CLAUSE: This coverage is subject also to the Current London Institute Radioactive Contamination Exclusion Clause and related U.S.A. Endorsement.

6.   TERRITORIAL CONDITIONS:

A.  Coverage is to apply from such time as packing shall commence at origin residence and be continuous during normal course of transit until unpacking is completed at destination residence provided that all other Terms and Conditions of  the All Risk Protection Group Policy are met.

B.  Coverage at warehouse of country of origin is provided for up to 90 days, and for up to 90 days after arrival at warehouse of final destination is provided, warranted that the property is stored in enclosed protected warehouses. Coverage for local moves and local office moves exclude any storage coverage unless specifically purchased by shipper.

C.  Storage coverage extension may be granted subject to prior notice and payment of additional premiums to the Underwriters as per the Storage Coverage Extension Form, forming part of this Policy.  Extension is subject to approval and validation by the Underwriters.

7.     CONDITIONS AND EXCLUSIONS

A.  100% Co-Insurance Clause: The applicant shall at all times maintain coverage on 100% value of his shipment to the extent of the replacement cost at destination (replacement value at today's replacement cost), at the time of loss or damage and failure to do so, the covered person shall to the extent of such deficit, bear his or their proportion of any loss or damage including labor charges.

B.  Valuation Clause: The personal and household effects covered hereunder must be valued at the replacement cost at destination as supported by a complete valued inventory or at a minimum of US$2,750.00 per cubic metre. Coverage requires that high valued items be specifically declared and valued. The settlement based on full replacement value coverage will be the lesser of repair cost/replacement value or as stated on the valued inventory. The Underwriters reserve the right to replace the damaged or missing items of like kind and quality.

C.  Agreed Value Clause: Notwithstanding anything to the contrary herein, it is hereby declared and agreed that in case of a claim arising in respect of all or any item or items appearing on the enrolment form, the value reflected against such item or items shall not be regarded as and agreed value between the Underwriters and the Applicant, notwithstanding that an Enrolment Certificate has been issued in respect of the total amount or amounts of suchenrolment form. The actual value and amount recoverable in respect of each and every item lost or damaged will have to be provided by the Applicant to the Underwriters - the maximum amount recoverable being the sum covered or the replacement value at destination, whichever is the lower.

D.  High Value Items Clause:  High value items and/or items not normally shipped in a household goods shipment and valued at over US$1,500 per item or set must be specifically declared and valued prior to issuance of the Enrolment Certificate.  Failure to comply with the requirements will limit recovery to a maximum of US$1,500 per item or set.  High Value Items are defined as, but not limited to the following:  Antiques, objects of art, valuable carpets, china, crystals, jewelry, silver and gold items, firearms, collection of records, tapes, pictures, paintings and other like goods.