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Vehicle / Heavy Equipment Fire Assignment Form
Your Details:
Your Name
Your Company Name
Your Direct Phone Number
Your Direct Email Address
Your Location (city)
Your Claim Number
Your File Number (if different from Claim Number)
Date of Loss
Security on Scene?
Yes
No
Insured Details:
Name(s) of Insured
Insured's Phone Numbers
Location Where Vehicle Burned
Location of Vehicle Now
Vehicle Information & Details of Loss:
Make
Model
Year
Colour
VIN
License Plate Number
Is Vehicle Still on Warranty
Yes
No
Location of Loss
Present Location of Vehicle
Description of Fire Event (leave a few line here)
Other Details:
Fire Department Investigator (Name, Phone, File Number)
Police Investigator (Name, Phone, File Number)
Upload All Statements
Drag & Drop Files Here
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