Send Us An Assignment

RNI Investigation Authorization

Required Field

Has RNI worked this case before? Yes No

Case Title

Client File #

Insured's Name

Can contact? Yes No

Insured Contact Name

Insured Telephone ext

Date of Loss

Job Description

Legal Representation yes no

If so, name

Date of Trial

Deadline

Check as needed

Surveillance How many days , provide instructions below

Public Record Inquiries

Financial Investigation

Assignment Instructions

Video Format? VHS DVD

Available Information on Subject of Investigation

Name

Address

City

State

Zip

Phone ext

SSN

Date of Birth

Height

Weight

Race

Sex Male Female

Drivers License

Spouse / Live-in

Children (name / DOB). 00/00/00 format Add more children

Injury / Limitations

Additional Info

Client Identification and Authorization:

Client Name

Company

Address

City

State

Zip

Phone ext

Fax

By submitting this document you agree to the following statements:

Fees and Budget with regard to this assignment will be agreed upon in writing prior to commencing the investigation.
I authorize Research North, Inc. to undertake the above detailed investigation. I understand and agree that payment in full for the above investigation is due within 15 days from the date of invoice.

I Agree