CIC Worldwide - Referal Form

CIC Worldwide

Online Referral Form

Send your online referral by filling out the form below:

	Customer Information
Name:		Company:
Address:		Phone:	Fax:
		E-Mail:
City:	County:	Post Code:

Subject/Claimant Information

Claim No (if known):		Address:
Subject Name:
Phone:		City:	County:
NI No (if known):		Post Code:
DOB:	(dd/mm/yy format)	Type of Claim (if any):
Injury:		Date of Loss:	(dd/mm/yy format)


Stated Sickness:		Employer Phone:
		Employer E-Mail:
		Height:	Weight:
Job Duty:		Race:
		Hair Color:
		Sex:	Male Female
Subject Currently Employed:		Comments:

Investigative Request

	Surveillance
		Comments/Instructions:
	Other Investigation Required?
		Comments/Instructions:
	Background Investigation
		Asset Trace Legal Background Check Business Interests Motor Vehicle Tag Search Locate/Skiptrace NI Number Verification Asset Income Report	Other:
		Comments/Instructions:

	Personal Activity Check
		Comments/Instructions:
	Special Investigations
		Claimant Interviews Recorded Statements and Interviews Witness Location Pace Interviews	Other:

Reporting and Procedures

Report:	E-Mail Hard Copy Mailed
Invoice:	Hard Copy Mailed

Video:	VHS CD-ROM
Status Update:	Verbal Update E-Mail Update No Update
Comments/ Instructions:
C.C. Parties:
Report Video Information:
Report Video Information:
Report Video Information:
Report Video Information:

FAQ