Marlin's Special Investigations, Inc. - Information Request / Case Assignment

Online Information Request / Case Assignment Form

Please use the form below to submit your case directly to us and an investigator with Marlin's Special Investigations, Inc. will be in contact with you.
NOTE: The more information you can provide in your form the faster we will be able to expedite your case.

Thank you

*Company/Person Requesting Investigation/Surveillance*

Adjuster/Client
Phone Number	Cell Phone
Address
City	State	Zip
Date	Claim #	* Insurance Companies
Email
Employer	Address
City	Phone
Deadline Date	Date of Injury
Authorized Amount
Nature of Injury
Restrictions/Limitations

*Claimant Information*

Claimant's Name
Address
City		State	Zip
Home Phone Number
Cell Phone Number
Date of Birth
Approximate Age	* If DOB is unknown
Social Security Number
Height		Weight
Eyes		Hair
Race		Sex
Facial Hair		Glasses
Other distinguishable characteristics of Claimant

Places the Claimant may frequent

*Claimants Occupation*

Occupation	Employer
Address	City
State	Zip	Phone

Claimant's Additional or Previous Addresses

Address		City
		State
Address		City
		State

*Others Residing at Claimant's Residence*

Name		Age
Relation
Name		Age
Relation
Name		Age
Relation
Name		Age
Relation

*Nearby Relatives*

Name	Age	Address
Relation
Name	Age	Address
Relation
Name	Age	Address
Relation

*Associates of Claimant*

Name	Age	Address
Name	Age	Address
Name	Age	Address

*Claimant's Vehicles*

Color		Make
Model		Year
Plate #
Color		Make
Model		Year
Plate #
Color		Make
Model		Year
Plate #

*Medical Information*

Doctor's Name	Address
City	State	Zip
Known upcoming appointments - Date	Time
Therapists Name	Address
City	State	Zip
Known upcoming appointments - Date	Time