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

1. Insurance Company * Reported By
2. Report To * Telephone Number
3. Policy Number   Effective Dates
4. Claim Number   Contract Number
5. Date of Loss * Email Address
6. Assured   Telephone Number

7. Owner/Operator

Telephone Number

Address 1     

Address 2     

8. Unit Number

Vehicle (Year Make Model Serial #)

9. Stated Amount   Deductible

10. Type of Loss

Comprehensive    Theft    Collision    Fire

11. Drive Info & Age

12. Scene of Loss

13. Loss Description

14. Location of Unit
15. Investigative Authority
16. Lien Holder
17. Unit Leased

18. Company Request

PhotosAppraisalA.C.V.Police ReportSubrogationIssue ProofSell SalvageStatement

19. Notes

 

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