HOUSEHOLD GOODS SELF SURVEY FORM

Shipper Name
Contact No
Email
Company Name
Origin Address
Landmark

Origin Floor
Is lift available for loading /
unloading
Destination Address
Landmark
Desination Floor

Is Lift Available at Destination

- Passenger / Service
Articles to be Moved

Item Qty Value Item Qty Value Item

Sofa: 1 Seater TV - 21" to 30" Pram

Sofa: 2 Seater TV - 31" to 40" Pooja Mantap
Sofa: 3 Seater TV - 41" to 50" Bean Bags

Sofa: 4 Seater TV - Above 51" Suitcases

Sofa: 5 Seater TV Trolley Trunks
Centre Table TV Cabinet Pots (without plants)

Side Table Fridge - Regular Ladder

Dining table - 4 Seater plastic Fridge - Large Ex- Cycle

Dining table - 8 Seater Washing M/c Tread Mill

Dinning Chair Dryer Cycle
Dining table - Glass Top Dishwasher Mirrors

Table Music System Pictures

Chair Home Theatre Small Carpet
Single Cot VCR/VCD/DVD Big Carpet
Single Mattress Computer Baby Car and cycle
Double Cot with or without
box Microwave Fish Tank
Double Mattress OTG Quilt
Baby Cot Cooking Range Barbeque Small

Deewan Gas Stove Barbeque Big

Dressing table Grinder Plants
Small Cupboard Water Filter Small Carton 18"x18"x10"

Large Cupboard A/c split or window plz specify Medium Carton 18"x18"x20"
Show case - 5 Feet Cooler Large Carton 18"x18"x30"
Book Rack Inverter Fan
Shoe Rack Batteries Bike
Side Board 2 Door Wardrobe
Chest of Draw 3 Door Wardrobe
Study Tabe 4 Door Wardrobe
Bunk Bed Garden Table
Wooden Chest Garden Chairs
Other Articles to be Moved
Item Qty Item Qty Item

Vehicles
Two wheeler Quantity, Make & Model

Four wheeler Quantity, Make & Model

Other Vehicle Quantity, Make & Model

Important Information
Preferred packing date
Preferred dispatch date
Time by when goods should be moved out of residence at origin (Mandatory)
Preferred delivery date at destination
Should Insurance to be arranged by …
If yes what is the Insurance value
Is Crating required for any fragile items. If Yes, specify items
Do you require storage in transit at origin or at destination
Should any items be got down through balcony using rope / crane etc. If yes pls specify
items / details
Is there easy access for loading and unloading at origin and destination
Are there any time restrictions for loading / unloading at origin or destination
Are there any items which are difficult to handle
Should goods be collected from more than 1 location at origin
Should goods be delivered to more than 1 location at destination
Who is paying for the move?
Are there any prohibited items Eg. Gas Cylinder, Kerosene, Perishable items etc. ?
Is Handyman (Carpentry, Plumbing, Electrician) services required?
Will any goods be Packed or Unpacked By you?
Are there any high value items over INR 1 Lakh?

Do you have any special needs or concerns? (If yes, kindly mention the same)

Important Notes

• Empty or Full Gas Cylinders cannot be carried as it is falls under dangerous goods category and we do not have a licence to transport the same. Insurance for goods will be vo
cylinders are carried in same vehicle.
• Live Plants cannot be sent with household goods. Transport of plants if required can be quoted separately.
• Crating of fragile items like Dining table glass top, TV LED etc. is mandatory to cover insurance
• Packers & Movers is a Packing and Moving company, hence we do not provide any Handy-man services like - Carpentry, Plumbing, Electrical work etc. Hence complicated ass
disassembly of Modular Furniture, AC, Walter filter, Washing Machine Wardrobes etc, is not covered as part of our standard services and can be arranged separately at an add
FORM

Qty Value
 Qty

me. Insurance for goods will be void if

al work etc. Hence complicated assembly or

n be arranged separately at an additional cost.