Report to Telephone Company Claim # Instructions for Assignment Insured Recorded Statement Agreed cost of repair Insured vehicle Claimant Recorded Statement Agreed cost of repair Claimant vehicle Witness Recorded Statement Total loss evaluation Photo/Diagram/Measurements of scene Move salvage A.S.A.P. Obtain Police Report Agreed price appraisal audit service Canvass for witnesses Handle subrogation Rule out bodily injury Determine comparative negligence Obtain Medical Authorization Other: Obtain Wage Authorization Property Appraisal Service Loss Information Producer/phone Policy Number Date of Loss   Effective Date Expiration Date Insured Name Address Telephone Loss Location & Description Authority contacted Report # Violations   Loss Payee Deductible Insured vehicle - Year Make Model VIN Damaged Area Owner Name & Address Telephone Drivers Name & Address Telephone Where can insured vehicle be seen Where can claimant vehicle be seen Description of Claimant Property Damage Claimant Name & Address Telephone Injured Parties Name & Address Telephone Extent of Injury Other Info