Claims Bureau New England

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ASSIGN AN INVESTIGATION

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NEW INVESTIGATION or Click here To Re-open a File     

 RUSH       Needed by:  
 

..........Liability Claims, Workers' Comp., Home Owners'........

Statements - Recorded and/or Foreign Statement - Locate People - Interrogatories - Bailment Documents - Accident Scene Locus - Obtain Documents such as Birth Certificates, Death Certificates -Police Reports - MV or Scar Photos - Discreet - Burglary - Fire: Cause & Origin  -  Other

 

Investigation:  

        
    
 

COMPANY INFORMATION

 

 
Company's Name
Your Name:
Telephone & Extension
E-Mail address:
New Customers Only...
Please enter your address.  Thanks.

 

 Claim Number:  
 Policy Number  
 Date of Accident  
 Time of Accident  

 

INSURED INFORMATION 

 
Permissive Use Issue?   YES     NO
Insured:
Address: 
City & State:
Tel. #: 
DOB: 
SSN / Lic No.:

 

 

SUBJECT#1   
Subject
Address & Apartment No.:
City & State
Tel. #: 
DOB
SSN / Lic No.:
Subject Description:
Vehicle
Interpreter Needed?
Represented? YES      No  
If Yes: Attorney's Name, Address & Telephone
 

Additional Comments: 

 

SCENE LOCUS INFORMATION: 

 

Information we should take note on:  Insured's Vehicle Operator's Name and vehicle description.   Adverse Operator's Name and vehicle description.   Location of Accident:  Direction of Travel and Point of Impact to vehicles.  Obstructions we should note, sunshine a factor or weather conditions?  Was there a third vehicle involved?  If so, please add some details here.   Additional accident scene comments: 

 

      

 

ADDITIONAL INFORMATION

  

 

     

Thank you for assigning an investigation to Claims Bureau New England, Inc.  We will be in touch with you shortly.   Jerry  800.342.8877

 

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