Title Page

  • Document No:

  • RÉFÉRENCE INVENTORY OF HOUSEHOLD ASSETS / INVENTAIRE DES AVOIRS DOMESTIQUE

  • SITE / COMPANY /SOCIETE

  • Conducted on

  • Prepared by

  • Location
  • PEOPLE PRESENT / PERSONNES PRÉSENTES

  • DESCRIPTION

IDENTIFICATION

  • FULL NAME / NOM

  • OWNER PICTURE / PHOTO DU PORTEUR

  • ID NUMBER / NUMÉRO CARTE D'IDENTITÉ

  • ID PICTURE / PHOTO DE LA CARTE D'IDENTITÉ

  • TELEPHONE NUMBERS / NUMEROS DE TELEPHONE

  • ADRESS /ADRESSE

  • ALTERNATIVE CONTACT / ADRESSE ALTERNATIVE

INFORMATION ON ASSETS / INFORMATION DES AVOIRS

    ASSET / AVOIR DOMESTIQUE
  • TYPE ASSET / TYPE D'AVOIR DOMESTIQUE

  • PICTURE OF ASSET / PHOTO D'AVOIR DOMESTIQUE

  • GPS COORDINATES

  • DESCRIPTION SPECIFICATIONS ASSET / DESCRIPTION SPÉCIFICITÉS D'AVOIR DOMESTIQUE

  • REMARKS / REMARQUES

SIGNATURES

  • SIGNATURE OWNER / PROPRIÉTAIRE

  • SIGNATURE AGENT CSR

  • GOVERNMENT AGENCY / DÉPARTEMENT DE GOUVERNEMENT

  • SIGNATURE AGENT GOUVERNEMENT

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