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Investigation Service Order

Order Factual or Fraud Investigation

Mayne Consultants and Investigators will consider taking instructions from you in this matter subject to our examination of the information supplied by you. Your opportunity to submit this information in this form does not constitute an agreement by us to accept your instructions. We will contact you to discuss the matter usually within 24 hours.

We guarantee your privacy and we will act with discretion.

Name
Business/company name
Business address
Contact name
Contact's phone number
Contact's mobile numer
Contact's fax number
Contact email
Retype email
Type of matter to be investigated
Your reference
Claim number
Name of matter (if litigated)	- v -
Date of injury or event
Circumstances of injury or event (for new paragraph hit enter twice)
Has legal action commenced	Yes / No
Statement of Claim or other court Document	If any documents or images are available, please email these to us making full reference to this matter.
If not litigated, please supply claim form
Claim form
Documents in support of action
Has police been notified	Yes / No
If YES, please supply details
Claimant/plaintiff/subject details - full information is needed particularly if the subject can be approached by our investigator.
Subject First name
Subject Surname
Subject Address
Telephone
Email
DOB
Driver Licence #
Alias
Place of birth
Nationality
Ethnic background
Occupation
The Insured (defendant) name
Is this employer your insured?	Yes / No
Employer's address
Any additional information regarding the insured?
Has the matter been investigated previously?	Yes / No
If YES, give details
Please explain the circumstances of your instructions to investigate
Payment - what method of payment will you be using for our services
Please select

The act of submitting the webform to us constitutes authority for us to proceed on your behalf.

If you have difficulties using this form or would prefer a different method of instructing us to act for you, please contact us.

Your Instructions to Investigate