Investigative Consultants & Associates

Investigative Authorization Form

Please include as much information as possible. Items marked with an asterisk (*) are required.

Contact Information
*Report to Whom?
*Address
*Phone	Fax
E-mail Address
*Type of Investigation
Your File #	Case #
Type of Injury
Insured's Name
Insured's Contact
Telephone #	Is contact permissible? Yes No
Date of Loss/Injury	Last Day Employed
Trial Date
Written Report Deadline	Verbal Report Yes No
Subject of Investigation
*Full Name
Street Address
City	State Zip Code
Telephone	Date of Birth
Sex	Male Female
Race
Height	Weight
Hair Color	Eye Color
Glasses?	Yes No
SSN	Driver's License
Vehicle	Color
License Plate #
Marital Status
Dependants
Last Known Employer
Contact
Occupation
Attorney
Add'l comments /instructions