Household Movers' Disclosure Requirements

APPENDIX 1
NOTICE REQUIRED ON ESTIMATE FORM/COMPUTER SCREEN
The following notice shall be placed in a prominent place, in at least 12-point
type, on a moving company’s required written estimate (if printed). If the estimate is
provided electronically, this statement must be of a size that, when printed on 8 by 12
inch paper, equates to 12-point type.
WARNING: If a moving company loses or damages your goods, there are 2 different
standards for the company’s liability based on the types of rates you pay. BY FEDERAL
LAW, THIS FORM MUST CONTAIN A FILLED-IN ESTIMATE OF THE COST OF
A MOVE FOR WHICH THE MOVING COMPANY IS LIABLE FOR THE FULL
(REPLACEMENT) VALUE OF YOUR GOODS in the event of loss of, or damage to,
the goods. This form may also contain an estimate of the cost of a move in which the
moving company is liable for FAR LESS than the replacement value of your goods,
typically at a lower cost to you. You will select the liability level later, on the bill of
lading (contract) for your move. Before selecting a liability level, please read “Your
Rights and Responsibilities When You Move,” provided by the moving company, and
seek further information at the government website www.protectyourmove.gov.
APPENDIX 2
VALUTION STATEMENT REQUIRED ON BILL OF LADING
The following notice shall be placed in a prominent place, in at least 10-point type, on a
moving company’s required bill of lading (if printed). If the bill of lading is provided
electronically, this statement must be of a size that, when printed on 8 by 12 inch paper,
equates to 10-point type.
REQUIRED VALUATION CLAUSE AND ESTIMATE OF COST OF SHIPMENT AT
FULL-VALUE PROTECTION
THE CONSUMER MUST SELECT ONE OF THESE OPTIONS FOR THE
CARRIER’S LIABILITY FOR LOSS OR DAMAGE TO YOUR HOUSEHOLD
GOODS
CUSTOMER’S DECLARATION OF VALUE
THIS IS A STATEMENT OF THE LEVEL OF CARRIER LIABILITY
—IT IS NOT INSURANCE
Option 1:
The Cost Estimate that you receive from your mover MUST INCLUDE Full
(Replacement) Value Protection for the articles that are included in your shipment. If

you wish to waive the Full (Replacement) Value level of protection, you must complete
the WAIVER of Full (Replacement) Value Protection shown below.
Full (Replacement) Value Protection is the most comprehensive plan available for
protection of your goods. If any article is lost, destroyed, or damaged while in your
mover’s custody, your mover will, at its option, either: 1) repair the article to the extent
necessary to restore it to the same condition as when it was received by your mover, or
pay you for the cost of such repairs; or 2) replace the article with an article of like kind
and quality, or pay you for the cost of such a replacement. Under Full (Replacement)
Value Protection, if you do not declare a higher replacement value on this form prior to
the time of shipment, the value of your goods will be deemed to be equal to $6.00
multiplied by the weight (in pounds) of the shipment, subject to a minimum valuation for
the shipment of $6,000. Under this option, the cost of your move will be composed of a
base rate plus an added cost reflecting the cost of providing this full value cargo liability
protection for your shipment.
If you wish to declare a higher value for your shipment than these default amounts, you
must indicate that value here. Declaring a higher value may increase the valuation charge
in your cost estimate.
The Total Value of my shipment is: ________ (to be provided by customer)
Dollar Estimate of the cost of your move at Full (Replacement) Value Protection:
________________________ (to be provided by carrier)
I acknowledge that for my shipment I have: 1) ACCEPTED the Full (Replacement)
Level of protection included in this estimate of charges and declared a higher Total Value
of my shipment (if appropriate); and 2) received a copy of the “Your Rights and
Responsibilities When You Move” brochure explaining these provisions.
X____________________________________
Customer’s signature

_____________
Date

------------------------------------------------OR---------------------------------------------Option 2:
WAIVER of Full (Replacement) Value Protection. This lower level of protection is
provided at no additional cost beyond the base rate; however, it provides only minimal
protection that is considerably less than the average value of household goods. Under
this option, a claim for any article that may be lost, destroyed, or damaged while in your
mover’s custody will be settled based on the weight of the individual article multiplied by
60 cents. For example, the settlement for an audio component valued at $1,000 that
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weighs 10 pounds would be $6.00 (10 pounds times 60 cents).
Dollar Estimate of the cost of your move under the 60-cents option: _______________.
COMPLETE THIS PART ONLY if you wish to WAIVE The Full (Replacement) Level
of Protection included in the higher cost estimate provided [above] [on the prior page] for
your shipment and instead select the LOWER Released Value of 60-cents-per-pound Per
Article; to do so you must initial and sign on the lines below.
I wish to Release My Shipment to a Maximum Value of 60-cents-per-pound per
Article.
____
(Initials)
I acknowledge that for my shipment I have: 1) WAIVED the Full (Replacement) Level of
protection, for which I have received an estimate of charges, and 2) received a copy of
the “Your Rights and Responsibilities When You Move” brochure explaining these
provisions.
X____________________________________
Customer’s signature

_____________
Date

APPENDIX 3
(Optional language that carriers may choose to include in the Required Valuation Clause
printed in Appendix 2)
Deductibles
You may also select one of the following deductible amounts under the Full
(Replacement) Value level of liability that will apply for your shipment. (If you do not
make a selection, the “No Deductible” level of full value protection that is included in
your cost estimate will apply):
[List here all deductibles offered, with a space to fill in the estimate of cost of a
full value move at that deductible filled in]
Amount of Deductible and
(Estimate of Total Cost of
Move)

Customer to write initials beside selected
deductible

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$0

Deductible (_________)

$XXX Deductible (_________)

_____________ (Customer writes in initials
to Select a deductible)
_____________

$XXX Deductible (_________)

_____________

$XXX Deductible (_________)

_____________

And so on.
Declaration of Article(s) of Extraordinary (Unusual) Value
I acknowledge that I have prepared and retained a copy of the “Inventory of Items
Valued in Excess of $100 Per Pound per Article” that are included in my shipment and
that I have given a copy of this inventory to the mover’s representative. I also
acknowledge that the mover’s liability for loss of or damage to any article valued in
excess of $100 per pound will be limited to $100 per pound for each pound of such lost
or damaged article(s) (based on actual article weight), not to exceed the declared value of
the entire shipment, unless I have specifically identified such articles for which a claim
for loss or damage may be made, on the attached inventory.
X_________________________________
(Customer’s Signature)

___________________
(Date)

APPENDIX 4
The following notice shall be placed on the bill of lading for household goods shipments
involving a motor carrier segment and an ocean segment.
The provisions of the Carriage of Goods by the Sea Act and/or of 49 U.S.C.
14706(f)(2) (a provision in the Interstate Commerce Act) permit us to offer
“released” rates (reduced rates under which you will not be fully reimbursed if
your shipment is lost, damaged, or destroyed), but they also require that we offer
rates that will better protect a consumer in the event of loss or damage to a
shipment. Under the rates offered here, your reimbursement in the event of loss
will be limited to __________________________.

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We also offer higher levels of protection (at higher rates). Signing this document
below indicates that you agree to pay and be bound by the terms of the released,
limited-recovery rates.
_______________________
(Customer’s Signature)

_________
(Date)

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