Home  |  Benefits  |  Claims Mgmt System  |  Experience  |  Claim Assignments  |  Contact Us  |  Fee Schedule  |  Coverage Area  |  Login Vehicle Damage Appraisal Assignment Insurance Company:  Examiner/Adjuster Name:  Mr   Ms   (First Name)   (Last Name) Examiner/Adjuster Email:    Examiner/Adjuster Phone:   Ext:  Examiner/Adjuster Fax:   Ext:  Company Claim Number:  Policy Number:  Date of Loss:  January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Type of Loss:  --Select-- Aircraft Civil Authority Collapse Disappearance Earthquake Electricity Explosion Falling Objects Fire Flood Food Spoilage Freezing Glass Breakage Hail Hurricane/Monsoon Ice/Snow Lightning Mischief Other Riot/Civil Commotion Smoke Theft Third Party Property Damage Tornado/Cyclone Vandalism Volcanic Eruption Water Damage Water/Steam Wind Insured or Self Insured Information Please enter either the insured's name or the Doing Business As (D.B.A.) company name. Insured Name:  Mr   Ms   (First Name)   (Last Name) (D.B.A.) Enter 'Insured' address, contact name, and phone numbers only if necessary for this assignment. If we are dealing with claimant property damage, please skip ahead to the Claimant Information section. Address:    City:     State:  --Select-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY   Zip:    Insured/Contact Cell Phone:   Ext:  Insured/Contact Home Phone:   Ext:  Insured/Contact Work Phone:   Ext:  Insured Vehicle Details    --Select-- Automobile, SUV, Light Truck Tractor/Trailer Motorcycle Boat Power/Construction Equipment Snowmobile ATV Mobile Home/RV   1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Year Make Model Vehicle Color:  License Plate:  VIN:  (last 6 digits)    Please detail vehicle impact points. Vehicle Damage Area:     Please detail exact vehicle location, address, phone, etc. Vehicle Location Info:    Type of Claim:  CollisionComprehensiveProperty Damage Deductible:  --Select-- $250 $500 $1000 (Other)  or other amount:  Appraisal Instructions:  Appraise Damage Photograph Damage Obtain Agreed Price with Shop of Owner's Choice Other:   Claimant Information Claimant Name:  Mr   Ms   (First Name)   (Last Name) (D.B.A.) Address:    City:     State:  --Select-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY   Zip:    Claimant/Contact Cell Phone:   Ext:  Claimant/Contact Home Phone:   Ext:  Claimant/Contact Work Phone:   Ext:  Claimant Vehicle Details    --Select-- Automobile, SUV, Light Truck Tractor/Trailer Motorcycle Boat Power/Construction Equipment Snowmobile ATV Mobile Home/RV   1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Year Make Model Vehicle Color:  License Plate:  VIN:  (last 6 digits)    Please detail vehicle impact points. Vehicle Damage Area:     Please detail exact vehicle location, address, phone, etc. Vehicle Location Info:    Type of Claim:  Liability Appraisal Instructions:  Appraise Damage Photograph Damage Obtain Agreed Price with Shop of Owner's Choice Other:   Appraisal Instructions To help speed up the assignment entry process please check the appropriate box(es) and enter any details, instructions, and/or service request into the Additional Assignment Instructions box below. Material Papers Forwarding Options For your convenience we've added the Material Papers Fax Option and the Material Papers Attachment Option to help expedite the assignment process. Please use one of the options below to send any material papers such as (police reports damage appraisals, etc.) that you feel should accompany this assignment. I will be faxing  page(s) in addition to the cover page I will be emailing additional material papers after submitting this request Hardcopy vs. Email Option We prefer to submit our entire file to you by email. This helps speed up the claim process, avoids losing "paper" and reduce clerical costs which help to reduce our service costs. However if you require a hardcopy of the entire file or a part thereof, please check the appropriate box(s) below. I don't require any hardcopy documents. Emailed documents will suffice. Please provide hardcopies of: Photographs File Reports Material Papers Southern Claims Inc Activity Sheet(s) and Service Invoice I understand that all Southern Claims Inc files will be deleted 12 months after the assignments have been closed by the assigned Southern Claims Inc . If required for a longer period of time, please transfer your data system and/or print to hardcopy file.   Type the following verification code into the box below:

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