Cargo Theft Loss Report

CTIP - Cargo Theft Loss Report

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Name

Primary Phone

Secondary Phone

Email Address

Date/Time of Theft (mm/dd/yyyy)

Location of Theft

Reported to (agency)

Case No.

Carrier, Warehouse or Company in Possession of Cargo at Time of Theft

Value of Stolen Cargo

Type of Product Stolen

Brand

Model

Quantity

Serial Numbers

Insurance Company

Insurance Phone Number

Insurance Adjuster

Trailer Make

Trailer Year

Trailer Color

Trailer License Plate

Trailer Value

Tractor Make

Tractor Year

Tractor Color

Tractor License Plate

Tractor Value

How did theft occur

Was Vehicle Hijacked?

Yes

Suspect Description

Were Weapons used? Weapons Used Has equipment been recovered? Recovered By

Additional Information