Casualty Assignment Form

Casualty Assignment

Please note: * denotes fields that are required to be filled in.



:


Assignment Type

Please investigate and handle all exposures to conclusion.


Please complete the following tasks


Insured


Facts


Policy Information


Insured Vehicle (if Auto Loss)

:


Claimant Property Damage

(If yes, please include information under "Further Information or Instructions" below)


Injured Parties (Insured or Claimant)

(If yes, please include information under "Further Information or Instructions" below)


Witnesses

(If yes, please include information under "Further Information or Instructions" below)


Further Information or Instructions:

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