Police Reports Request Form

If you have a client access user ID and password, please click here to log in to Client Access and submit your request from there. If not, please fill out and submit this form and a user ID and password will be assigned to you.

You will have the option to add additional subjects and upload attachments after submitting this form.

Client Information

* - required fields
Your Information
Name: * Position: *
Company: Phone:
City: Toll free:
E-mail: * Fax:
Principal Company: File Number:
Principal City: * Policy Number:
Principal Toll Free: Principal Phone:
Principal Examiner/Adjuster: Principal Fax:
Independent Adjuster: Independent Adjusting Firm:
Claim Department: *

Loss Information

Insured(First/Last): * Did any fatalities occur?: *
Date of Loss: * (mm/dd/yyyy) Name of person who
reported the occurrence:
*
Type: *

Instructions

Type of Search: Other:
Video Format: USA Search:

Subject Information

Name (First/Last): * Date Of Birth: * (mm/dd/yyyy)
Address: Driver Lic #:
City: VIN: *
Province: * Postal Code:
Phone Number: Location of loss: *
Occurrence number: Type of occurrence: *
Driver Information: Police Officer's Name & Badge/
Policy Agency:
Comments:

Vehicle Information

Plate Number: Year:
Make: Model:
Additional Details:

 

If authorization is required, you will be notified by one of our investigators.



 

Please note: A service fee will apply if you request to cancel this order or do not provide enough information to obtain the report.