ASSIGNMENT SHEET

There are three ways in which you can submit an assignment to us.

     1.  Contact the appropriate office by phone or fax.

     2.  Email the appropriate office all the information regarding the assignment.

     3.  Fill out the form below and submit.

Should you have any questions, please feel free to give any one of our offices a call.

Please Provide the Following Client Contact Information:

First Name:  Last Name:  Organization:  Title:  Address:  City:  Prov./State:  Postal/Zip code:  Work Phone:  Fax:  Email:  Your File #:  Loss Date:   (yyyy/mm/dd) Insured:  Principal:

Please Provide the Following Assignment Information:

Subject 1st Name:		Subject Last Name:
Gender:	Male        Female	Date of Birth:	(yyyy/mm/dd)
Subject Address:
City:		Province:
Home Phone:		Work Phone:
Description:		Employment Details:
SIN:		DL No.:
Vehicle Info.:

Please Provide the Following Investigation Details:

Case Particulars:		Injuries:
Investigation Details:	Financial   Surveillance   Activities   Background   Other   -   Please Specify:

What is your budget for this assignment? 

 

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