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Investigation Service Order

Order Surveillance 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 for which surveillance is required
Your reference
Claim number
Date of injury or event
Nature of injury or event (for new paragraph hit enter twice)
The Subject (to be observed)
Gender	Male Female
First Name
Surname
Address
Other known addresses
Telephone
Email
DOB
Driver Licence #
State of issue
Alias
Place of birth
Nationality
Ethnic background
Occupation
Employer (current)
Is this employer your insured?	Yes / No
Employer's Address
If not your insured, name of your insured
Insured's address
Employer (previous)
Employer address (previous)
Has the subject been investigated previously?	Yes No
If YES, some details please
Description of subject
Height
Build
Hair
Distinguishing features
List vehicle make, model and registration number(s)
Is a medical appointment pending? Give details
Please explain the circumstances of your decision to investigate
Surveillance Requirements
Total hours
	To include travel time? Yes No
Number of days
Preferable days
Video?	Yes No
Photos?	Yes No
Due date of report
If report to be addressed to your legal representatives, please identify your lawyers
Payment - what method of payment will you be using for our services
Please select

Please email us a digital photograph(s) of the subject and ensure you refer in the email to your specific instructions in this matter.

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