New Assignments


Damage Adjustment Assignment Form

This Claim Assignment Form is for use by claim adjusters and company claim supervisors, and can be used to assign, heavy truck/trailer, cargo or heavy equipment adjustments. When the form has been submitted, it will be electronically forwarded directly to the adjuster.

Company Information:
**Note: If you are currently on file as a client of KinderCo, Inc. , you are not required to fill out this
form in it's entirety. Only the information pertaining to the specific assignment is necessary.

Company Name
Adjuster's Name
Adjuster's Email
Phone - Fax -
Address (1)
Address (2)
City
State/Province
Zip Code
Country

Claim Information:

Assigned To Michael Kinder
File Number
Policy Number
Date of Loss
Insured
Claimant
Address (1)
Address (2)
City
State/Province
Zip Code
Country
Home - Business Phone -
Vehicle Year - Make -
Vehicle Model
Vehicle License
VIN
Type of Loss
Deductible $
Point of Impact /
Loss Description:
Special Instructions
Vehicle Drivable
Vehicle Location
Phone
Shop Estimate(s)
Name of Shop(s) $
$

File Instructions:

Other

Photos
Other
Photo Format
Other

Adjustment Instructions:

Secure Police or Fire Report
Obtain Statement From Insured
Obtain Statement From Driver
Secure Salvage If Vehicle Is A Total Loss
Coverage Has Been Confirmed
Secure Proof From Insured (with company approval)

Salvage Instructions:

Value
Move To Pool

Call Back Instructions

Adjuster or Other
Repairable Loss
Total Loss