Name: (required) Date: Move From: Move To: Account for: Date of move: Phone (H): Phone (w): Cell: (required) Email: (required)

Insurance: Yes No Insurance type: All-risk insurance Transit-insurance Insurance value: R Packed by: Owner Patrick Removals Goods to be stored Yes No Period to be stored: Months Transport of Vehicles/Boats/ Trailers/Caravans Yes No Vehicles Boats Trailers Caravans 1. Make Year model Value R 2. Make Year model Value R Transport of pets: Yes No 1. Number of dogs: Breed: Kenneling: Days 2. Number of cats: Kenneling: Days

If you are unsure of the amount of cartons that you will be packing, please insert ? in the appropriate box and we will calculate cartons according to your household volume. LOUNGE Qty ENTRANCE HALL Qty DINING ROOM Qty KITCHEN Qty 3 Seater Couch Hat Rack Table (L) Table 2 Seater Couch Kist Chairs CHAIRS 1 Seater Couch Chair Sideboard Cabinet Chairs Tel. table Welsh dresser Microwave Oven Wall Unit parts Carpet Server Toaster Book Case (L) Pictures Tea Trolley Snackwicher TV Ornaments Carpet Vegetable Rack TV Cabinet Mirror Cabinet Crockery Carton Video Machine Table Pictures Tupperware Carton Mnet Decoder Mirror Stove Satellite Dish Ornaments Mini-Oven Display Cabinet STUDY Qty Fridge/Freezer Hi-fi Radiogram Desk Chest Freezer DVD Player Cabinet Bar Fridge Antennae Armchair FAMILY ROOM Qty Washing Machine Coffee Table Safe 3 Seater Couch Tumble Drier Side Tables Wall Unit 2 Seater Couch Dishwasher Carpet Carpet 1 Seater Couch Vacuum Cleaner Pictures Books Carton Chairs Polisher Ornaments Computer/Printer Wall Unit Ironing Board Organ/Piano Computer Stand Coffee Table Laundry Basket Clock: Grand Pictures Side Tables Brooms/Mops Show Case Ornaments Carpet Bin Hi-Fi Speakers Book Case Pictures Clothes Airer TV Trolley Ornaments Cooler Box

BEDROOMS Bedr 1 Bedr 2 Bedr 3 Bedr 4 Double Bed Headboard Pedestals Dressing Table Single Bed Wardrobe 2 Door Wardrobe 3 Door Dressing Table Stool Chest of Drawers Kist Armchair Mirror Cot Sewing Machine Over-locker Toy Box Carpet Ornaments Pictures Clothes Carton Linen Carton Rugs GARDEN EQUIP. Qty MISC. Qty Table Golf Bag/Clubs Chair Sport Equipment Bench Gym Equipment Swing Fixed Camping Equip. Swing Collapsible Pool Equipment Braai Fishing Rod Dustbin Gas Bottles Bird Bath Wendy House Hosepipe Trialor Jungle Gym -F/C Motorcycle Kennels Pram Bird Cages Heater/Fan Suitcases Lamp-Table Lamp-Standing OUTSIDE ROOM Qty SUNROOM Qty Bed Bench Wardrobe Chairs Table Chest of Drawers Dresser Pictures Chest Carpet Trunk Table Stove Ornaments Carpet Carton GARAGE Qty OTHER Qty Work Bench Pot Plants(s) Shelving Pot Plants(M) Cabinets Pot Plants(L) Lawn Mower Pot Plant Stand Weed Eater Bar parts Wheelbarrow Bar Chairs Garden Tools Bicycle OTHER ITEMS NOT LISTED: Planks Crates Trunks Machinery Ladder Toolbox Tricycle Drill Press Welder

Please supply us with the following information if possible: 1. Type of home House Duplex Townhouse Flat Farm 2. Easy access/entry for the truck at pick-up address: Yes No (IF NO) Reason 3. Easy access/entry for the truck at delivery address: Yes No (IF NO) Reason