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Assignment form for a expertise order
Fields that are marked with * are required.
Power of attorney / Insurance comp. *
Correspondent *
  Sir     Madam  
E-mail adress *
Phone number
INSURED
Intermediary *
  Sir     Madam  
E-mail adress *
Phone number
Counterparty (in case of liability)
Initial(s) *
Initial(s)
Insertion
Insertion
Surname *
  Sir     Madam  
Surname
  Sir     Madam  
Damage address
Address
Address
Address addition
Address
Address addition
ZIP code
ZIP code
Residence
Residence
Phone number 1
Phone number 1
Phone number 2
Phone number 2
Contact
Contact
E-mail
Address
Address
Address addition
ZIP code
Residence
Damage in favor of
Date of damage
Short discription and comments
(example, cause of damage, damage estimate)
Policy number
Ensured interest
Damage number
Coverage
Policy conditions
Insured amount
Attachments
( for example police report, quotation, etc )
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kakeswaal expertise opdracht
- expertise
   assignment