AUTOMOBILE ASSIGNMENT  From  Company  Policy #  Claim #  Insured  Phone (H)  (W)  Address  City  ST  Zip  Contact  Phone (H)  (W)  Address  City  ST  Zip  Date of Loss  Time  Authority Contacted  Report #  Location (Include City & State): Description  Vehicle #  Year  VIN  Plate #  State  Make  Model  Body Type  Owner  Phone (H)  (W)  Address  City  ST  Zip  Driver  License #  State  Phone (H)  (W)  DOB  Address  City  ST  Zip  Relationship to Insured  Purpose of Use  Permission to Use Describe Damage  Estimate Amount  Where Vehicle can be Seen  Describe Property (if applicable)  Veh/Prop Ins Y   N  Ins Co  Vehicle Number (if applicable)  Year  VIN  Plate #  State  Owner  Phone (H)  (W)  Address  City  ST  Zip  Driver  License #  State  Phone (H)  (W)  DOB  Address  City  ST  Zip Describe Damage  Estimate Amount  Where Vehicle can be Seen  Name & Address  Phone  INS VEH  OTH VEH  PED  AGE  Extent of Injury                                            Name & Address  Phone  INS VEH  OTH VEH  Passenger/Witness/Other                                TYPE  INTERVIEW  SECURE Full Investigation Insured Vehicle Driver Passengers CHP/Police Report Medical Authorization Medical Reports Limited Investigation Adverse Vehicle Driver Passengers Insured Vehicle Appraisal Adverse Vehicle Appraisal     Witnesses    PHOTOGRAPH   Insured Vehicle Adverse Vehicle Scene of Loss   Special Instructions  Date of Assignment:  Due Date: