Los Angeles Private Investigators - Investigators Serving Los Angeles and the State of California

Case Assignment Form

 

Completing the Case Assignment Form below allows us to conduct a preliminary review of your case so we will better be able to advise you of what steps and fees may be involved in conducting your assignment.

 

Please supply as much information as possible.

 

Case Details
Investigation Type:	Please Choose Surveillance Investigations Photo / Video / Covert Photography Product Infringement Investigations Intellectual Property Investigations Undercover Investigations Workers Compensation AOE/COE & Sub Rosa Personal Injury and Negligence Investigations Employee Integrity Investigations Background Investigations Sexual Harassment Investigations Witness locating and Statements Confidential Interviews and Interrogations Environmental Investigations Civil Court and Deposition Testimony Malingerer Consultations Business Intelligence Business Interruption Intervention Business Risk Assessments Industrial Espionage Consults TelCo Consultations Personal Protection Other
Other:
Completion Deadline:	Day: -- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  Month: -- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year:
Trial or Hearing Date:	Day: -- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  Month: -- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year:
Previous Surveillance Performed?	Yes:   No: (If yes, we will require a copy of your report)
Alleged Injury:
Physical Restrictions:
Claim Number
Date of Loss:	-- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  Month: -- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year:
Insured:
What is the purpose of this investigation?
Client Information
Are you a first time client?	Yes No
Company:
Full Name:
Address:
Address2:
City:
State:	Zip:
Phone:
Fax:
Email Address:
Secondary Client Information (if applicable)
Client:
Phone:
Fax:
Email:
Subject Details
Name:
Address:
Address2:
City:
State:	Zip
Telephone:
Date of Birth:
SSN:
Drivers Lic. #:
Subject Identifying Information
Sex:	Please Choose Male Female Unknown
Race:	Please Choose White Black Hispanic Asian Native
Hair:	Please Choose Black Brown Blonde Red Brunette Salt/Pepper Gray Other
Build:	Please Choose Small Medium Large Unknown
Height:	ft.    in.
Weight:	lbs.
Other Descriptive Details (tattoos, disabilities, scars, etc.):
Marital Status:	Please Choose Single Married Co-Habiting Unknown
Spouse Name:
Vehicle Information
Vehicle #1
Make:
Model:
Color:
Tag#	Year:
Vehicle #2
Make:
Model:
Color:
Tag#	Year:
Further Details
Does the subject have a history of violent behavior?	Yes (If yes, two crews are required) No
Restrictions:	Day Limit: Dollar Limit:
Are there specific days for the surveillance to be conducted on?	Yes   No (If yes, please detail)
If 2 crews are required (ie: rural areas), do we have permission to proceed?	Yes No
Special Instructions:
Has KSI's billing procedures been explained?	Yes No
Referred By:

 

 

 

 

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ADDRESS & PHONE

 

Knight Star Investigations
4470 W. Sunset Boulevard
Suite 107-251
Los Angeles, California 90027
Toll Free: 877 718 2834

Los Angeles: (213) 341 0173

San Francisco: (415) 449 1967
Fax: 877 718 2835

 

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