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BOB KINDER & SON, INC. ASSIGNMENT FORM
*=Required

Reported By: *
Telephone Number: *
E-mail Address: *
Report To:
Insurance Company:
Policy Number:
Effective Dates:
Claim Number:
Date of Loss:
Insured
Insured Telephone Number
Owner / Operator:
Street Address:
City:
State:
Zip Code:
Unit / Fleet Number:
Make / Model / VIN
Type Of Loss	Comprehensive Theft Collision Fire
Driver Information and Age
Scene Of Loss
Loss Description
Location Of Unit
Investigative Authority:
Lien Holder
Leased Unit?	Yes No
Leasing Company:
Company Request:	Photographs Appraisal A.C.V. Police Report Subrogation Issue Proof Sell Salvage Statement
Notes:


* Required

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