Upload
dothuy
View
238
Download
0
Embed Size (px)
Citation preview
Tender Reference
Head Office, Cape Town39 Willowweg/ Road, Stikland, 7530
Posbus / PO Box 131, Bellville, 7535
Tel: 021 948 4011
Fax: 021 946 4252
Email: [email protected]
Gauteng1008 Kruger Ave, Lyttleton
Posbus / PO Box 10464, Centurion, 0046
Tel: (012) 644-0071
Fax: (012) 644-1330
Email: [email protected]
BELANGRIKU word sterk aangeraai om goedere en meubels/huisinhoud vir
volle vervangingswaarde te verklaar. Geen eis sal betaal of
oorweeg word vir artikels wat nie op die vorm verskyn nie. Eise sal
geskik word in terme van totale verklaarde waardes. Sien
IMPORTANTYou are strongly advised to declare goods and furniture/household
content for its full replacement value. No claims will be paid or
considered for items not mentioned on the form. The claim will be
settled in terms of the total declared values. See Annexure A for
Email: [email protected]
Web: www.jhretieflogistics.co.za
Email: [email protected]
Web: www.jhretieflogistics.co.za
AANSOEKER /APPLICANT HUIDIGE WOONADRES / CURRENT RESIDENTIAL ADDRESS
AFLEWERINGSADRES / DELIVERY ADDRESS IF DIRECT DELIVERY GAAN U MEUBELS GESTOOR WORD /
WILL YOUR FURNITURE BE STORED?
oorweeg word vir artikels wat nie op die vorm verskyn nie. Eise sal
geskik word in terme van totale verklaarde waardes. Sien
aanhangsel A vir polisterme.
considered for items not mentioned on the form. The claim will be
settled in terms of the total declared values. See Annexure A for
policy terms.
DATUM VAN VERHUISING / REMOVAL DATE TIPE VERVOER / METHOD OF TRANSIT
Seevrag / Sea Freight Lugvrag / Air Freight Pad vervoer / Road transport
VUL ASSEBLIEF DIE INVENTARIS MET DIE WAARDE VAN ITEMS IN / KINDLY COMPLETE THE INVENTORY WITH THE VALUE OF ITEMS
Tipe/Make Model
Noitems
Vervangingswaarde/Replacement cost
A. Elektriese Toebehore/ Electrical Appliances
Tipe/Make Model
Noitems
Vervangingswaarde/Replacement cost
Yskas/Refrigerator Telefoon-Faks/Telephone fax
A. Elektriese Toebehore/ Electrical AppliancesYskas/Refrigerator Telefoon-Faks/Telephone faxVrieskas/Deepfreeze Televisie/TelevisionMikrogolf/Microwave Draagbare TV/Portable TVMini-oond/Mini oven Video-opnemer/Video recorderVoedsel verwarmer/Hot tray M-Net dekodeerder/decoderTweeplaatstoof/Hot plate Satellietskottel/Satellite dishStoof/Stove TV Antenna/TV AerialWasmasjien/Washing machine Stereo toerusting/equipmentTuimeldroer/Tumble dryer Klank versterker/AmplifierTuimeldroer/Tumble dryer Klank versterker/AmplifierSkottelgoedwasser/Dish washer Luidsprekers/SpeakersKetel/Kettle Kompakspeler/CD PlayerStrykyster/Iron Kassetspeler/Tape deckRooster/Toaster Draaitafel/Turn table"Snackwich" Draagbare radio/Portable radioKoffiemaker/Coffee maker Draagbare bandopnemer/recorderVoedsel verwerker/Food processor Projektor,skyfies/Projector, slidesElektriese mes/Electrical knife Klokradio/Clock radioVersapper/Blender Skeermes/RazorVersapper/Blender Skeermes/RazorWafelmaker/Waffle maker Sakrekenaar/CalculatorStadige kookpot/Slow cooker Haardroer/Hair dryerHandklitser/Hand mixer Haarkrullers/Hair curlersRooster oondjie/Toaster oven Breimasjien/Knitting machineBlikoopsnyer/Tin opener Naaimasjien/Sewing machineElektriese braaipan/Frying pan Omkapmasjien/OverlockerOlie braaier/Oil fryer Tikmasjien/Type writerElektriese/Electrical fondue Rekenaar/ComputerBedieningstrollie/Hot tray trolley Drukker/PrinterBedieningstrollie/Hot tray trolley Drukker/PrinterVerwarmer/Heater Skandeerder/ScannerWaaier/Fan Sagteware/SoftwareLugreelaar/Air conditioner Speletjies/GamesStofsuier/Vacuum cleaner Ander hardeware/Other hardwarePoleerder/Polisher (Specify)Matwasser/Carpet cleanerElekriese kombers/blanketElektroniese orrel/keyboard Ander/Other (specify)Elektroniese orrel/keyboard Ander/Other (specify)Elektroniese klavier/pianoAnder/Other (specify)
TOTAAL/TOTAL (A.) R TOTAAL/TOTAL (B.) R
C. KLERASIE / CLOTHING
Noitems
Vervangingswaarde /Replacement cost
E. BREEKWARE FRAGILES
Noitems
Vervangingswaarde /Replacement cost
G. EETKAMER / DINING ROOM
Noitems
Vervangingswaarde /Replacement cost
MANS/MEN Eetservies/Dinner service (1) Eetkamertafel/tableBaadjies/Coats Eetservies/Dinner service (2) Stoele/ChairsPakke/Suits Teestel/Tea set (1) Buffet/SideboardLeer/Leather/Suede clothing Teestel/Tea set (2) Teetrollie/Tea trolleyBroeke/Slacks Ander breekware - eetkamer/ Kabinet/CabinetKort broeke/Shorts Other crockery - dining room Silwerware/SilverwareTruie/Jerseys Ander breekware - kombuis/ Messeware/CutleryHemde/Shirts Other crockery - kitchen Gordyne/CurtainsNagklere/Sleepwear Glasware/Glassware Skilderye/PaintingsDasse/Ties Kristalware/Crystalware Drank/Wine/SpiritsOnderklere/Underwear Porselein/Porcelain Lamp/LampSkoene/Shoes Marmerblaaie/Marble topsStewels/Boots Ander marmer/Other marble Ander/Other (specify)Kouse/Hosiery Ornamente/OrnamentsSportdrag/Sportswear Spieels/MirrorsStrandklere/Beachwear Ander/Other (specify)Serpe/Scarves TOTAAL/TOTAL (G.) RSakdoeke/Handkerchiefs
Hoede/HatsH. KOMBUIS/KITCHEN
VROUE/WOMEN TOTAAL/TOTAL (E.) RBaadjies/Coats Tafel/Table
Pakkies/SuitsF. SITKAMER/LOUNGE Stoele/Chairs
Rokke/Dresses Kabinette/ChairsLeer/Suede/Leather garments Stoele/Chairs Strykplank/Ironing boardLang broeke/Pants Rusbanke/Sofas Groenterak/Vegetable rackKort broeke/Shorts Sitkamerstel/Lounge suite Potte en panne/Pots and pansRompe/Skirts Koffietafel/Coffee table Messegoed/CutleryTruie/Jerseys Sytafeltjies/Side tables Toebehore/UtensilsBloese/Blouses Vertoonkas/Showcase Plastiekware/PlasticwareNagklere/Sleepwear Tydskrifrak/Magazine rack Vullisblik/Dirt binOnderklere/Lingerie Kis/Kist Kookboeke/Cookery booksSkoene/Shoes Wynrak/Wine rack Nie-bederfbare voedsel/Stewels/Boots Boekrak/Bookcase Non-perishable foodKouse/Hosiery Kabinet/Cabinet Skoonmaakmiddels/Sportdrag/Sportswear Muureenheid/Wall unit Cleaning materialsStrandklere/Beachwear Lessenaar/DeskSerpe/Scarves Laaikas/Chest of drawersHoede/Hats Matte/Carpets Ander/Other (specify)Handsakke/Handbags Tapyte/Rugs
Horlosies/ClocksKINDERS/CHILDREN Lampe/LampsKlerasie/Clothing Boeke/Books TOTAAL/TOTAL (H.) RSkoene/Shoes Klavier/Piano
Musiekinstrumente/instrumentI. BADKAMERS/ BATHROOMS
Ander/Other (specify) Plate/RecordsKompakskywer/CD'sVideo/Audio cassettes Kabinet/CabinetSkilderye/Paintings Gordyne/Curtains
TOTAAL/TOTAL (C.) R Gordyne/Curtains Weegskaal/ScaleMuurbehangels/Wall hangings Toiletware/Toiletries
D. LINNE/ LINEN Kussings/Cushions Tafel/Table
Tafel/Table Medisyne/MedicinesOrnamente/Ornaments Grimeermiddels/Cosmetics
Tafellinne/Table linen Pottebakkersware/Pottery Wasgoedmandjie/Lakens/Sheets Clothing basketKussingslope/Pillowcases Ander/Other (specify) Tapyte/RugsDuvet Oortreksels/CoversDuvets/Quilts Ander/Other (specify)Komberse/BlanketsKussing/PillowsNagval/Night frillsHandoeke/Towels
Ander/Other (specify)TOTAAL/TOTAL (D.) R TOTAAL/TOTAL (F.) R TOTAAL/TOTAL (I.) R
J. SLAAPKAMERS / BEDROOMS
Noitems
Vervangingswaarde /Replacement cost
M.BUITE/OUTSIDE
Noitems
Vervangingswaarde /Replacement cost
Noitems
Vervangingswaarde /Replacement cost
Dubblelbeddens/Double beds Tuintafel/Garden tableDubble kopstukke/Headboards Tuin stoele/Garden chairs Heg aparte lys aan indien nodigEnkelbeddens/Single beds Tuingereedskap/Garden tools Attach separate list if necessaryEnkel kopstukke/Headboards Tuinbank/Garden benchBedkassies/Pedestals Strandstoele/Beach chairsSpieeltafels/Dressing tables Sambrele/UmbrellasStoeltjie/Stool Ornamente/OrnamentsStoele/Chairs Oefen toerusting/Kot/Cot Exercise equipmentKompaktum/Compactum Sport toerusting/Laaikassies/Chest of drawers Sport equipmentBoekrakke/Book cases Kamptoerusting/Kaste/Wardrobes Camping equipmentMatte/Carpets Braai toerusting/equipmentLampe/LampsLessenaars/Desks Ander/Other (specify)Kiste/Kists TOTAAL/TOTAL (O.) RSpieels/Mirrors
Skilderye/PaintingsGordyne/CurtainsBoeke/Books TOTAAL/TOTAL (M.) R OPSOMMING/SUMMARY
Speelgoed/Toys A. ELECTRICAL R
Ornamente/OrnamentsN. MOTORHUIS & STOOR/ GARAGE & STORE B. ELEKTRIESE R
Skoonheidsmiddels/ C. CLOTHING RCosmetics Stoele/Chairs D. LINEN RToiletware/Toiletries Rusbanke/Sofas E. FRAGILES RTasse/Suitcases Swembad toerusting/ F. LOUNGE RHorlosies/Clocks Pool equipment G. DINING ROOM RAnder/Other (specify) Werksbank/Workbench H. KITCHEN R
Kaste/Cupboards I. BATHROOMS RGereedskap kiste/Tool boxes J. BEDROOMS RGereedskap/Tools/(List specialised seperately)
K. STUDYL. MISCELLANEOUS
RR
Rakke/Shelves M. OUTSIDE RGrassnyer/Lawnmower N. GARAGE & STORE R
TOTAAL/TOTAL (J.) R Randsnyer/Weedeater O. VALUABLE ITEMS RLeer/Ladder (s)
K. STUDEERKAMER/ STUDY Kruiwa/Wheelbarrow Ander/Other (lys/list)
Fietse/BicyclesTapyte/Rugs Tapyte/RugsHorlosies/Clocks Swaai/SwingLampe/Lamps Hout/TimberBoeke/Books Boeke/Books SUBTOTAAL/SUB TOTAL RLessenaar/Desk Gasbottels/Gas bottlesStoele/Chairs Branderski's/Paddleski'sLiasseerkabinette/Filing cabinets Seilplank/SailboardRekenaarstaander/Comp.Stand Branderplank/SurfboardSkilderye/Paintings Boot/Boat
Sleepwa/TrailerTOTAAL/TOTAL (K.) R Gordyne/Curtains
Boor/DrillL. ALLERLEI/ MISCELLANEOUS Pottebakkersware/PotteryFotografie toerusting/ Ander/Other (specify)Photographic equipment(Limited to R5000 in total)(R1000 per item maximum)Specify :Silverware/SilverwareKristal/CristalSnoekertafel/Snooker tablePool tafel/table GROOT/GRAND TOTALTreinstel/Train set om te verseker/to be
TOTAAL/TOTAL (L.) R TOTAAL/TOTAL (N.) R insured R
Ek/Ons verlang dat, JH Retief, Volle Aanspreeklikheid aanvaar vir my/ons besending, onderhewig aan hulle Alle Risiko Goedere In Transito Polis voorwaardes en verklaar dat alle inligting korrek
en volledig is en dat ek geen wesenlike feite weerhou het nie. Ek stem saam dat die vorm as grondslag gebruik kan word vir die voorgestelde kontrak tussen myself/ons en JH Retief, die versekerde.
I/We wish apply that, JH Retief, accept Full Liability for my/our consignment, subjected to there All Risk Goods In Transit Policy conditions and declare thereafter that my information is correct and complete and that nothing
materially affecting the risk has been concealed by me. I agree that this form shall be taken as the basis of the proposed contract between me/us and JH Retief, the insured.
DATUM/DATE HANDTEKENING/SIGNATURE
O . WAARDEVOLLE ITEMS VALUBLE ITEMS (bo R1 000 elk/above R1 000 each eg antiques, artworkes, etc..
Our Financial Service Provider (The Broker)Phoenix Risk Solutions (Pty) Ltd FSP License nr: 10150 Postal Address : P.O.Box 140, Newlands, 7725 Tel: 021 683 8383 Fax: 086 511 6286