Serafin Investigations

732.946.3100

Serafin Investigations	Date: November 21, 2008
PO BOX 446
Colts Neck, NJ 07722
Phone: 732.946.3100	Named Insured
Fax: 732.946.8474	Claim Number
robert@serafininvestigations.com	Date of Loss

COMPANY INFORMATION
Company		Address1
Phone		Address2
Report To		City / State / Zip
Requested Report format E-Mail Tele-Fax Regular Mail
Email Address
Loss Location
CLAIMANT INFORMATION
Claimant Name		Claimant Address1
Home Phone		Claimant Address2
Work Phone		City/State/ZIP
Cell Phone		SS Number
Drivers License		Date Of Birth
DL State Issued
CLAIMAINT ATTORNEY INFORMATION
Attorney Name		Attorney Address1
Phone		Attorney Address2
Fax		City/State/Zip
INSURED INFORMATION
Insured Name		Insured Address1
Home Phone		Insured Address2
Work Phone		City/State/Zip
Cell Phone
INSURED ATTORNEY INFORMATION
Attorney Name		Attorney Address1
Phone		Attorney Address2
Fax		City/State/Zip

Full Investigation	Attempt to Locate	General Liability	Computer Searches	Workers Comp Investigation
Adjustment	Photo Auto/Claimant	Photo Auto/Insured	Product	Surveillance
Residency Check	Witness Canvas	Background Investigation	Video Tape	Prior Injury Investigation
Uninsured Motorist - Check Coverage & Assets			Uninsured Motorist - Check Assets
PIP Eligibility Investigation		Photos - Scene and Diagram

Statement - Insured(s)		Identify
Statement - Claimant(s)		Identify
Statement - Witness(s)		Identify
Statement - Police Officer		Identify
DMV Check		Specify
Records		Specify
Other		Specify

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After filling all fields please press Submit Claim button

Telephone: (732) 946-3100

Fax: (732) 946-8474