Authorization to Destroy Evidence

AUTHORIZATION TO DESTROY EVIDENCE
CASE/CLAIM #:*
POLICY #:
CARRIER/DEPARTMENT:
CASE NAME/INSURED:*
LOSS LOCATION:
INCIDENT DATE:

MonthDayYear
INVESTIGATOR CASE #:
AFA CASE #:
AUTHORIZING PERSON:*
CARRIER/AGENCY:*
ACKNOWLEDGEMENT I, {authorizingPerson} of {carrieragency14}, am authorized to permit Analytical Forensic Associates to destroy all the physical evidence from the above referenced case presently held in the secured evidence storage facility. I further understand that the evidence will be destroyed shortly after receipt of this authorization form.
SIGNED (or you may digitally sign below):

Clear
DIGITALLY SIGNED:
By typing my name above, I am electronically signing this Authorization to Destroy Evidence for this case.
DATE:*

MonthDayYear
ADDRESS:
CITY:
STATE/PROVINCE:
ZIP/POSTAL CODE:
PHONE:*
FAX:
EMAIL:*
Should be Empty:

AUTHORIZATION TO DESTROY EVIDENCE