INVESTIGATION REQUEST FORM
Date of Request: Subject's Name:
Requestor: Spouse's Name:
Email address: Address
Client Phone: City, State, Zip:
Client File: Phone Number:
Date of Loss: SSN:
Insured: DOB:
Insured Contact: Driver's License No:
Contact Number: State License Issued:

Type of Loss:
Select  

Investigation requested
Place an X by the item number(s) reflecting the action(s) you request and fax or E-mail to jmunn@cssi.net
1. DATABASE BACKGROUND CHECK: Criminal and Civil search-State and Federal; SSN trace; MVR for license and accidents; vehicle registrations; comprehensive data searches; people search for locates.
   
2. SURVEILLANCE: Specify budget and any other specific instructions here (i.e. 3 days or monetary limit  or specific coverage such as appointments, etc):
   
3. SPECIAL INVESTIGATIONS:  Fire Claims (suspicious fire or subrogation potential); Casualty Claims; Workers’ Compensation Claims; Recorded Statements; Subrogation/Assets; Locate;  Service of Process
   
4. PRE-SURVEILLANCE: neighborhood survey to assess feasibility of surveillance (includes ID of property, vehicles, and confirms subject actually resides at given address.
   
5. ACTIVITY CHECK: Neighborhood canvass to determine current status and activities of claimant
   
6. ALIVE & WELL or DEPENDENCY CHECK: Please specify handling instructions such as Direct Interview with Claimant (recorded if requested); neighbors; database background search, etc.  
   
7. PUBLIC RECORDS: Field investigation at court houses for suits and judgments; property records; marriage licenses, etc.
   
8. SPECIAL INSTRUCTIONS or OTHER INFORMATION you feel is useful:
   

CORPORATE SPECIAL SERVICES, INC
205.987.4870     800.239.2774     205.987.9363 (Fax)    Email: jmunn@cssi.net


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