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Insurance Bureau of Canada/qc/Business/Business Crime/Cargo Theft/Cargo Theft Incident Form

Cargo Theft Incident Form

GENERAL THEFT DETAILS:

Type of theft is a required field
Date / time of theft is a required field.
Location of theft is a required field

POLICE DEPARTMENT REPORTED TO:

Police Agency is a required field
Police Division is a required field
Report/Occurence No is a required field

VEHICLE DETAILS:

Vehicles is a required field
Year is a required field
Make is a required field
Model is a required field
Colour is a required field
Decals is a required field
VIN/Chasis No. is a required field

CARGO DETAILS:

Product Description is a required field
Brand is a required field
No. of pieces is a required field
Container Serial No. is a required field.

INSURANCE INSURED DETAILS:

Insured's name is a required field
Driver's Name is a required field
Drivers license is a required field.

INSURANCE COMPANY DETAILS:

Insured's cliam no. is a required field.
Examiner Name/Phone is a required field.
Document attached is a required field.
additional comments is a required field.

VOLUNTARY INFORMATION:

(You are not required to fill out this section.)

* Information contained in this document is for the sole purpose of data collection. Whereas, the carrier, Canadian Trucking Alliance and the Insurance Bureau of Canada (IBC) do enter into an agreement to share information for the purposes of investigating motor vehicle theft and related offences, such as but not limited to conspiracy, fraud, and possession of stolen property. The information will be forwarded by secure email to an IBC analyst and subsequently forwarded to the named contact person from the respective Police Service. Any disclosure of information pursuant to this agreement shall be only for the stated purpose. There shall be no dissemination or disclosure of the information to any other agency, body or organization including but not limited to the media without prior approval.
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