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Colonial Claims Service

SURVEILLANCE ASSIGNMENT FORM

  • All required fields are marked with a red asterisk *
  • Please provide as much information as possible
  • Please attach claim documents in a separate email
    to frontdesk@colonialclaimsservice.com OR fax supports to 978-741-2343

Account Information



*Company:
*Claim No.:
*Adjuster/assignor name:
*City:
*Phone #:
*Date of loss: MM/DD/YYYY
*Address:
*State: *Zip code:
E-mail:

Assignment Instructions:*

Activity Check
Other

Assignment Details:
*Number of hours

Breakdown of Hours:

Number of Full day(s)
Number of 1/2 Days
Specific Time AM PM
Specific Date
Location
   

Background Investigation Authorization

   
Subject Locator Activity Check
Criminal History Asset Check
Civil History Other
Driving Records

Subject information*

Claimant Witness Other

First: Last:
Address:
City:
State: Zip code:
Additional information:

Reporting Requirements:

Initial Reporting:
Verbal 7 Days 21 Days 30 Days