Submit a Forensic Assignment

New Assignment & Evidence Chain of Custody Online Submission

Please complete the fields below to submit your assignment.

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Submit a Forensic Assignment

Date of Loss*
Contact Information
Claim Number
Primary Contact Name*

First

Last
Title
Company
Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Phone*
Fax
Primary Contact Email*
Insureds Information

Additional site contact information may also be noted here.
Insureds Name

First

Last
Insureds Phone
Additional site contact information as applicable
Billing Information

Please complete this section if billing information differs from the primary contact information noted above.
Billing Contact

First

Last
Billing Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Phone
Email*
File Information

Please provide any special instructions and job request details in this section.
Loss Location*
Loss Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Scope of Work*

Please include the Scope of Work Requested / Special Instructions / Additional Information
Email
Report Type
Send Report Via
Evidence

If evidence is being sent in conjunction with this assignment, please complete the following fields. Submission of evidence with this form, is an agreement between the submitting party named as the primary contact and JENSEN HUGHES that any such evidence is covered by the JENSEN HUGHES Evidence Storage Agreement and Liability Statement which is available upon request.
Is evidence being sent with this assignment?
- No
- Yes
File
Drop files here or
Attach evidence or other files needed for the assignment as needed.
Evidence Submission Method
Evidence Disposition after Analysis/Examination
Evidence Details
Comments

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Submit a Forensic Assignment

New Assignment & Evidence Chain of Custody Online Submission

Please complete the fields below to submit your assignment.

Submit a Forensic Assignment

Contact Information

Insureds Information

Billing Information

File Information

Evidence

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