Kodsi Engineering

New Assignment Form

If you require immediate attention or if you would like to consult with us initially, please call us at (416) 977-0009

You may also use our PDF Form and fax it to (416) 977-6622 or fill out the form below

TYPE OF INCIDENT/LOSS:
DATE OF INCIDENT/LOSS:
LOCATION OF LOSS:
INSURED’S/CLIENT’S NAME:
CLAIM/FILE NO.:
POLICY NO.:
CLIENT CONTACT:
COMPANY NAME:
MAILING ADDRESS:
PHONE:
FAX:
CELL:
E-MAIL:
PURPOSE OF INVESTIGATION:
EXAMINATION – TYPE AND LOCATION:
COMMENTS SPECIAL INSTRUCTIONS:
TYPE OF REPORT REQUESTED:


New Assignment Form