Personalized Assignment Form Request Personalized Assignment Form Request To make it easier and faster for you to assign a claim, we provide personalized assignment forms, which will have your contact information filled in every time you access the form. ** THIS IS NOT AN ASSIGNMENT FORM ** Name: * Email Address: * Company: * Company Address: * City: * State/Province: * Zipcode: * Phone Number: * Fax Number: Form Type * Workers Comp Investigation Assignment Form Life & Disablity Assignment Form If you are human, leave this field blank.