Subject Information
First Name Middle Name Last Name Social Security No. Date of Birth
AKA(s) if any Street Address City State Zip Code
Telephone Drivers Lic. No. Occupation Marital Status Spouse Name

Sex

Race Height Weight Hair Color Eyes

Glasses

 Facial Hair Complection
Descriptive Remarks Nearest Relative List Vehicles Dependents
Click if previous address and contact information is known. Click if case is litigated to add Case Information.
Employer Information
Company Name Contact Name Street Address City State Zip
Phone No & Ext. May we contact?  
Defense Attorney Information
Law Firm Name Street Address City State
Zip
Attorney Name Assistant Name Phone Number & Ext. Fax Number
File Number  
Insurance Carrier Information
Company Name Street Address City State
Zip
Adjuster Name Assistant Name Phone Number & Ext. Fax Number
Claim Number Date(s) of Injury  
Pertinent Case Information
Date of Injury Type of Injury Subject uses
Address where injury occurred Does the Subject have any Restrictions?
What are your suspicions/Red flag ingicators?
Appointments or important dates upcoming? Date Time Location
Prior investigations done? Who would you like us to update/CC?
Database Searches
WCAB Prior Claims
Social Security Number
National Database Pro.
Criminal History Search
Civil History Search
Asset Search
Locate/Skiptrace
Other

Secure Records
WCAB Records
Employment Records
Insurance Records
Police Records
Criminal Records
Medical Records
Birth/Death Certificate
Other

 Objectives - Notes

Request ordered by Due Date Rush?

Days/Hours of surveillance authorized: