SUBMIT A CASE | NCC - National Claims Control - Private Investigative Services in California

NCC - NATIONAL CLAIMS CONTROL - PRIVATE INVESTIGATIVE SERVICES - SANTA CRUZ, CALIFORNIA

PI License #13832

Thanks for choosing National Claims Control! There are 4 parts to the simple form below.

* Please fill in as many or as few items as you wish, but the more details you provide, the faster we will be able to help you.

Part #1 - Your Details
(Unless you're a returning customer, please supply your full contact information. If you are a returning customer, simply fill in your name.)

		Name:

		Company:				(if applicable)

		Address Line 1:

		Address Line 2:

City:

State:

Zip:

Country:

(if non-US)

Telephone:

(include area code)

Extension:

(if applicable)

		Email Address:

		Title:

		Best Time To Contact:				(HH:MM:SS, 20:30:00) AM PM Any

		Preferred method:				Phone Email Mail

		Send Film in Format:

Part #2 - Defense Attorney (if any)

Attorney to receive a copy? Yes No
If no, please skip to Part 3. If a report is to be addressed and mailed to an attorney, please include attorney name and address here.

		Attorney Name:

		Law Firm:				(if applicable)

		Address Line 1:

		Address Line 2:

City:

State:

Zip:

Country:

(if non-US)

Telephone:

(include area code)

Extension:

(if applicable)

		Email Address:

		Send Film in Format:

Part #3 - Case Details

Service Type:

Surveillance/Sub Rosa Location Service Subrogation Process Service
or Other:

Records:
Obtain any/all records Obtain any/all records and provide summary
Obtain records from limited locations:

Obtain records from limited locations and provide summary:

Background Services:
Full Background Check Partial Background Check Prior Claims Investigation Asset Check
Details:

Statements:
Claimant statement only Employer/witness statement(s) only Claimant and employer-level statements Other

Due Date:

Time Authorized:

Specific Days to be Run:

Date of Loss:

Claim #:

		Occupation:

		Employer:

		Employer Contact:				(if necessary)

		Address Line 1:

		Address Line 2:

City:

State:

Zip:

Country:

(if non-US)

		Employer Telephone:				(include area code)

		Alleged Injury:

		Restrictions:

		Complaints:

		Special Instructions:

		Currently Working?

Part #4 - Claimant Details

Name:

Gender:

Male Female

		Address Line 1:

		Address Line 2:

City:

State:

Zip:

Country:

(if non-US)

Telephone:

(include area code)

Occupation:

		Social Security:

		Date of Birth:				or Approximate Age:

Height:

Feet Inches

Weight:

Lbs.

Build:

Facial Hair:

Hair Color:

Length/Style:

Eye Color:

Glasses:

		Race:				Caucasian / African-American / Hispanic / Middle-Eastern, etc.

		Distinguishing Marks:				scars/tattoos, etc.

		Vehicle 1:				(color, make, model, plate number)

		Vehicle 2:				(color, make, model, plate number)

		Vehicle 3:				(color, make, model, plate number)

		Any Other Details:

		Prior Address:

		Previously Investigated?

		Aware?

Applicant's Attorney

		Attorney Name:

		Law Firm:				(if applicable)

		Address Line 1:

		Address Line 2:

City:

State:

Zip:

Country:

(if non-US)

Telephone:

(include area code)

Extension:

(if applicable)

		Email Address:

		Send Film in Format:

		Security Code:				Notes: Please key in the security code shown on the above image.