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Online Assignment
Online Assignment
Report To:
Email:
Company:
Fax:
Telephone:
Claim #:
Claim Information
Type of Loss:
Auto:
Property:
General Liability:
Date of Loss:
Policy #:
Effective Date:
Expiration:
Insured Name:
Telephone:
Cell Phone:
Work Phone:
Address:
City:
State:
Zip:
Deductible:
Auto/Liability Claim Information
Authority Contacted :
Report #:
Loss Location :
City:
State:
Zip:
Insured Vehicle Year:
Make:
Model:
Vin:
Damaged Area:
License #:
Claimant Name:
Home Phone:
Cell Phone:
Work Phone:
Claimant Address:
City:
State:
Zip:
Claimant Vehicle Year:
Make:
Model:
Vin:
Damaged Area:
License #:
Instruction for Assignment
Agreed Appraisal-Insured
Obtain Police/Fire Report
Agreed Appraisal-Claimant
Photo/Diagram of Scene
Total Loss Worksheet
Obtain Medical Authorization
CCC Worksheet
Move Salvage
Recorded Statement-Insured
Submit appraisal for approval
Recorded Statement-Claimant
Obtain Salvage Bids
Recorded Statement-Witness
Marshall & Swift Evaluation
Other: Please Specify
Property Claim Information
Mortgagee:
Coverage Limits:
Dwelling
Other Structures
Personal Properties
Loss of Use
Special Handling Instructions:
Home
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Services
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Locations
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Online Assignment
Home Office
North Central Adjustment Company
10501 Buena Vista Court
Urbandale, IA 50322
P: (515) 278-2875
F: (515) 278-2870
