Evidence Transmittal Form

EVIDENCE TRANSMITTAL/CHAIN OF CUSTODY
Submitting Investigator
Name:*
Company:*
Address:
City/State or Province/Zip or Postal:
Phone:*
Fax:
Email:*
Case Number:
Report and Statement Information
Client's Name:
Company:
Address:
City/State or Province/Zip or Postal:
Phone:
Fax:
Email:
Case Information
Case Name or Insured:
Loss Date:

MonthDayYear
Loss Location:
City/State or Province/Zip or Postal:
Claim Number:
Policy Number:
Artifact Year Make/ Model:
Identification Number:
Please describe the evidence in detail and include location from where evidence was recovered. (Example: One gallon can containing burned carpet, padding and debris removed from the center of the living room by the love seat
Item 1:
(90 characters max)
Item 2:
Item 3:
Item 4:
Item 5:
Item 6:
Item 7:
Item 8:
Special Instructions:
Chain of Custody
From (or you may digitally sign below):

Clear
Digitally Signed:
By typing my name above, I am electronically signing this transfer of evidence form for this case.
Should be Empty:

EVIDENCE TRANSMITTAL/CHAIN OF CUSTODY