Forensic Accounting Assignment Form

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If you do not wish to use this online form, please download the PDF version of the form, which you can then complete and email to assignments@ingardus.com.

If you do not receive an acknowledgement from us within one business day, please contact us at assignments@ingardus.com or (317) 917-1176.

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Who is the calculation on behalf of (e.g., insured, claimant, other)?*

Insured:

Claimant:

Date of Loss

Loss Location

End of Loss Period (if known):

Claim, Policy or File Number:*

Amount(s) Claimed:*

Event Giving Rise to Claim:

Service Requested:

Contact Person & Telephone Number at Insured's, Claimant's, Plaintiff's, or Defendant's office

Coverage Considerations

Coverage limitations

(e.g., coinsurance, deductibles)

Client Contact Information

Adjuster or Attorney Name*

First Name Last Name

Adjuster or Attorney Telephone Number*

Email Address*

Company Name:

Bill to Address

Street Address Address Line 2 City State ZIP Code

Miscellaneous Information & Comments:

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"You went beyond what was expected or what most people would do and gave us all the courage and hope we needed in order to seek justice. Loyalty, a hand shake agreement and integrity are unfortunately no longer the norm of doing business. " - Sr. Susan Durkin, President, Ursuline Sisters of Cleveland