INTER TRANS INSURANCE SERVICES, INC.

9311 Irvine Boulevard, Irvine, California 92618

US (800) 251-0678 * FAX (949) 305-7241 * PHONE (949) 305-7220

HOUSEHOLD GOODS AND PERSONAL EFFECTS: Rates quoted are for "All Risk" coverage and include "War Risk”, strikes, riots and civil commotion, and 90 days storage at origin and/or destination. All insurance coverage is door to door unless otherwise stated on the certificate. Please note that all items in the shipment must be insured. Any policy that covers only a limited number of items in the shipment is subject to rejection or will be co-insured. Also, coverage will be rejected should any application be for other than the usual mixture of household goods; i.e. over 50% of the value being in one class of items, such as computer equipment, or in any one group, such as antiques, china, art objects, etc., unless I.T.I. is notified prior to shipment. A commodity certificate or an additional premium may be necessary.

In the absence of a valued inventory, insurance must be purchased for a minimum of $2,300.00 per cubic meters or $10.00 per pound for full replacement value plus high value items (replacement value at or more than $500.00) or a co-insurance penalty will be assessed. When insuring personal vehicles, an auto condition report is required at origin and destination. Please note that we will not cover marring, denting, chipping, scratching or pre-existing damages for vehicles over three years old.

Pairs & Sets is an additional coverage. The insurance does not cover an entire set if any single item(s) is lost or damaged. Payment will only be made for the proportionate value of the item(s) lost or damaged. If this option is selected, we would consider the entire set as one item. If an item(s) of the set could not be repaired or replaced, we would replace the entire set.

Mechanical & Electrical is an additional coverage. The insurance does not cover any internal electrical or mechanical component of any device unless exceptions are noted at time of delivery for external damage to such property. Loss of data and recalibration are also excluded. If this option is selected, we would cover internal breakage with no external damage. Please note that data loss is still not covered.

RATES:Surface shipments...... $3.00/$100.00...... No deductible

...... $200.00...... Minimum premium

Air shipments...... $3.00/$100.00...... No deductible

...... $180.00...... Minimum premium

Local...... $2.50/$100.00...... No deductible

...... $200.00 ...... Minimum premium

Domestic...... $2.80/$100.00...... No deductible

...... $200.00 ...... Minimum premium

Miscellaneous ...... $0.50/$100.00...... Storage per month (over 90 days)

...... $0.25/$100.00 additional.....Pairs & Sets Coverage

...... $0.25/$100.00 additional.....Mechanical & Electrical Coverage

CLAIM INFORMATION: Please send us the valued inventory, origin inventories, bill of lading, delivery documents, auto condition report, exceptions taken at time of delivery and if possible, picture of the damages.

APPLICATION FOR PROTECTION

Moving By: (Check One): Land Sea Air

Applicant Name: ______Pack Date: ______

Origin Street Address: ______

Destination Street Address: ______

Email Address: ______

Please choose either the “Lump Sum Valuation”or the “Itemized Valued Inventory,” check off the appropriate section,complete the form in its entirety, sign where indicated and return to your move manager before the packing of yourbelongings begins.

LUMP SUM VALUATION

I have selected the Lump Sum Valuation option of US $10 per pound (in the U.S.) or US $2,300 per cubic meter (outside of theU.S.) times the weight or volume of the shipment. Attached is a Valued Inventory Form that lists items that exceed US $500 or equivalent in other currency in value and any vehicles. Volume or weight will be confirmed by your mover manager within two days of packing.

ITEMIZED VALUED INVENTORY

I have selected the Itemized Valued Inventory option. Attached is a complete Valued Inventory Form listing everything that will be included in this shipment.

PROTECTION ENHANCEMENTS

 I have selected Pairs & Sets Coverage

I have selected Electrical or Mechanical Derangement Coverage

I have had explained to me the key features and benefits of this product. I have read the Terms and Conditions of this policy.

Signature: ______Date: ______