Investigation Assignment Form
CLIENT INFORMATION
Date of Request:
Requesting Firm:
Contact Name:
Phone number:
Client File Number:
Date of Loss:
Your Client (if app.):
Insured: (if app.)
File Budget:
SUBJECT INFORMATION
Subject Name:
Street Address:
City:
Phone:
DOB:
SIN#
Alleged Injury or Claim:
Photo enclosed: Yes No
Employer:
Address:
Position held:
Restrictions:
Claimant Comments:
CLIENT INSTRUCTIONS
Background Investigation
Vehicle search:
Corporate search:
Property Search:
Business License:
Bankruptcy:
Divorce:
Civil Claims:
Employment Status:
Criminal records:
Background Comments:
Surveillance Investigations
Special instructions:
Consecutive Days: How Many? 2 3 4 5 6 7 8 9 10 Other
Interviews/Statements
Police:
Co-workers:
Neighbours:
Witnesses:
Claimant:
Family:
Instructions:
Additional Information
Is the Claimant currently receiving benefits?
No Yes
Does the Claimant have other sources of income?
Was the Claimant previously investigated?
Does the Claimant have legal representation?
Claimants Doctor:
Claimants Lawyer:
Activities and lifestyle:
Gryphon
investigations
