Claim Information Form PDF Details

The CCC Valuescope Basic Claim Information Form plays a critical role in the insurance claims process, serving as a comprehensive tool for capturing all relevant details necessary for processing a claim efficiently and accurately. It is designed to facilitate easy reporting and retrieval of claim information through various methods, including email, fax, or other specified means, ensuring that adjusters can access the data they need in a timely manner. The form requires intricate details such as the office ID number, claim number, adjuster and appraiser names, contact information for both, and specifics about the insured and owner, including names and contact numbers. Pertinent details about the loss, such as ZIP code, state, type of loss (collision, theft, etc.), and coverage codes, are vital for determining the scope and nature of the claim. Additionally, information on the vehicle involved in the claim, including the VIN, year, make, model, body style, engine size, mileage, and much more, offers a complete picture of the physical and functional attributes of the vehicle prior to the loss. This form also extends to capture details on refurbishments, special features, additional options, and condition ratings, providing a thorough assessment of the vehicle's condition and value. Adjustments for pre-tax, sales tax, and post-tax calculations are included to facilitate a comprehensive evaluation of the claim from a financial perspective. In essence, the CCC Valuescope Basic Claim Information Form is integral to the insurance claims processing landscape, ensuring that claims are assessed accurately and comprehensively.

QuestionAnswer
Form NameClaim Information Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesinformation claim form, bcif ccc, ccc one bcif, claim form information

Form Preview Example

CCC Valuescope Basic Claim Information Form

Report Retrieval

 

 

 

 

Email

 

 

 

 

 

 

 

 

Fax

 

 

 

 

 

Other (Specify)

 

 

 

 

 

 

 

 

 

Method

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CCC Phone: 1-800-621-8070

 

 

 

CCC Fax: 1-800-621-7070

 

CCC Email: CCCValuescopeRequest@cccis.com

 

 

 

 

 

Office ID Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Claim Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjr Name (First & Last)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appr Name (First & Last)

 

 

 

 

 

 

 

 

 

 

 

 

Adjr Contact#

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Insured’s Name

 

 

 

 

 

 

 

 

 

 

 

 

Owner’s Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner’s Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Loss ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Loss State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Loss Type

Collision

Theft

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Coverage code

Collision

Comprehensive

 

Liability

Other

3rd Party Claim

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Leased Vehicle

Yes

No

 

 

 

 

 

 

 

 

 

Date of Loss

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Exch#Policy #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjuster ID#

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Claim Class

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PA Appr ID#

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Year

 

 

 

 

Make

 

 

 

 

 

 

Model

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Body Style

 

 

 

 

2DR

 

 

 

4DR

 

 

 

 

 

Hatchback

Convertible

 

Wagon

 

 

 

Pickup

 

Van

 

Utility

½ Ton

 

 

 

¾ Ton

 

 

 

1 Ton

 

 

Short Bed

 

Long Bed

 

Cab & Chassis

 

 

 

Fleetside

 

Fenderside

Engine Size

 

 

 

 

 

 

 

Cylinders

 

3

 

 

 

4

 

 

 

5

 

6

 

 

 

8

 

 

10

 

 

12

 

 

 

Turbo

 

Diesel

Mileage (“UNK” if unknown)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Transmission

 

 

 

Automatic

 

S6

 

 

 

 

 

 

S5

 

S4

 

 

S3

 

 

 

OD

 

 

 

 

4W

 

PO

Power Options

 

 

 

 

 

 

 

Seating

 

 

 

 

 

 

 

 

Roof

 

 

 

 

 

 

Exterior/Paint/Glass

 

PS Power Steering

 

 

 

 

CS Cloth Seats

 

 

EG Electric Glass Roof

 

 

 

 

 

RR Luggage/Roof Rack

PB Power Brakes

 

 

 

 

LS Leather Seats

 

 

ES Electric Steel Roof

 

 

 

 

 

WG Woodgrain

 

PW Power Windows

 

 

 

 

RL Reclining/ Lounge Seats

 

 

OR Skyview Roof

 

 

 

 

 

WP Rear Window Wiper

PL Power Locks

 

 

 

 

BS Bucket Seats

 

 

SD Dual Power Roofs

 

 

 

 

 

2T Two Tone Paint

 

SP Power Driver Seat

 

 

 

 

SH Heated Seats (2)

 

 

MS Manual Steel Roof

 

 

 

 

 

D2 Deluxe 2 Tone Paint

PC Power Passenger Seat

 

 

 

 

RH Rear Heated Seats

 

 

MG Manual Glass Roof

 

 

 

 

 

HP Three Stage Paint

PA Power Antenna

 

 

 

 

3S Third Row Seat

 

 

FR Flip Roof

 

 

 

 

 

 

 

 

IP Clearcoat Paint

 

PM Power Mirrors

 

 

 

 

3P Power Third Seat

 

 

TT T-Top/Panel

 

 

 

 

 

MP Metallic Paint

 

PT Power Trunk/Tailgate

 

 

 

 

R3 Retractable Seats

 

 

GT Glass T-Top/Panel

 

 

 

 

 

SL Rear Spoiler

 

PP Power Adjustable Petals

 

2P 12 Passenger Seating

 

 

MV Manual Convertible Roof

 

 

FL Fog Lamps

 

PD Power Sliding Door

 

 

 

 

5P 15 Passenger Seating

 

 

VP Power Convertible Roof

 

 

TG Tinted Glass

 

DP Dual Power Sliding Doors

 

B2 Captain Chairs (2)

 

 

RM Detachable Roof

 

 

 

 

 

DT Privacy Glass

 

Décor/Convenience

 

 

 

 

B4 Captain Chairs (4)

 

 

VR Vinyl Roof

 

 

 

 

 

BN Body Side Moldings

AC Air Conditioning

 

 

 

 

B6 Captain Chairs (6)

 

 

RF Cabriolet Roof

 

 

 

 

 

DM Dual Mirrors

 

DA Dual Air Conditioning

 

 

 

Radio

 

 

 

 

 

 

 

 

LR Landau Roof

 

 

 

 

 

HM Heated Mirrors

 

CL Climate Control

 

 

 

 

AM AM Radio

 

 

LP Padded Landau Roof

 

 

 

 

 

HV Headlamp Washers

RD Rear Defogger

 

 

 

 

FM FM Radio

 

 

PV Padded Vinyl Roof

 

 

 

 

 

MX Signal Integrated Mirrors

IW Intermittent Wipers

 

 

 

 

ST Stereo

 

 

 

 

 

 

 

 

CT Soft Top

 

 

 

 

 

 

Other

 

 

 

 

 

TW Tilt Wheel

 

 

 

 

 

 

 

 

CA Cassette

 

 

HT Hard Top

 

 

 

 

 

 

 

 

BD Running Board/Side Steps

TL Telescopic Wheel

 

 

 

 

SE Search/Seek

 

 

Safety/Brakes

 

 

 

 

 

 

 

 

UP Power Retractable

CC Cruise Control

 

 

 

 

CD Compact Disc Player

 

 

AG Air Bag

 

 

 

 

 

 

 

 

 

 

Running Boards

KE Keyless Entry

 

 

 

 

SK CD Changer/Stacker

 

 

RG Passenger Air Bag

 

 

 

 

 

XE Xenon Headlamps

CN Console/Storage

 

 

 

 

UR Premium Radio

 

 

XG Front Side Impact Air Bags

 

 

AR Bed Rails

 

CO Overhead Console

 

 

 

 

XM Satellite Radio

 

 

ZG Rear Side Impact Air Bags

 

 

BL Bedliner

 

EC Entertainment Center

 

 

 

 

TQ Steering Wheel Touch

 

 

DG Head/Roof Air Bags

 

 

 

 

 

BY Bedliner (Spray On)

NV Navigation System

 

 

 

Controls

 

 

 

 

 

 

 

 

TD Theft Deterrent/Alarm

 

 

 

 

 

CP Fiberglass Cap

 

C2 Communications System

 

M3 Auxiliary Audio Connection

VZ Night Vision

 

 

 

 

 

GG Grill Guard

 

HU Heads Up Display

 

 

 

 

EQ Equalizer

 

 

IC Intelligent Cruise

 

 

 

 

 

SB Rear Step Bumper

WT Wood Interior Trim

 

 

 

 

CB CB Radio

 

 

PJ Parking Sensors

 

 

 

 

 

SS Swivel Seats

 

EI Electronic Instrumentation

 

8T 8 Track Tape Player

 

 

PX Parking Sensors W/Equip

 

 

SW Rear Sliding Window

IB On Board Computer

 

 

 

Wheels

 

 

 

 

 

 

 

 

AB Anti-Lock Brakes (4)

 

 

 

 

 

PG Power Rear Window

MC Message Center

 

 

 

 

AW Aluminum/Alloy Wheels

 

 

A2 Anti-Lock Brakes (2)

 

 

 

 

 

TB Tool Box (Permanent)

MM Memory Package

 

 

 

 

CJ Chrome Wheels

 

 

DB 4-Wheel Disc Brakes

 

 

 

 

 

TN Tonneau Cover – Soft

RJ Remote Start

 

 

 

 

W2 20” or Larger Wheels

 

 

RB Rollover Protection

 

 

 

 

 

TZ Tonneau Cover – Hard

 

 

 

 

 

 

 

 

 

 

 

 

DC Deluxe Wheel Covers

 

 

TX Traction Control

 

 

 

 

 

TP Trailering Package

 

 

 

 

 

 

 

 

 

 

 

 

FC Full Wheel Covers

 

 

T1 Stability Control

 

 

 

 

 

WD Dual Rear Wheels

 

 

 

 

 

 

 

 

 

 

 

 

SA Spoke Aluminum Wheels

 

 

AL Auto Level

 

 

 

 

 

XT Auxiliary Fuel Tank

 

 

 

 

 

 

 

 

 

 

 

 

SY Styled Steel Wheels

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3D 3rd Truck Door

 

 

 

 

 

 

 

 

 

 

 

 

 

WW Wire Wheels

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4D 4th Door Truck/Van

 

 

 

 

 

 

 

 

 

 

 

 

WC Wire Wheel Covers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BC Bumper Cushions

 

 

 

 

 

 

 

 

 

 

 

 

RW Rally Wheels

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BG Bumper Guards

 

 

 

 

 

 

 

 

 

 

 

 

KW Locking Wheels

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EM California Emissions

 

 

 

 

 

 

 

 

 

 

 

 

LC Locking Wheel Covers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SG Stone Guard

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WI Winch

 

1

BCIF 01, CA

 

 

 

 

CCC Valuescope Basic Claim Information Form

(Continued)

Office ID Number

 

 

 

 

 

 

 

 

 

 

Claim Number

 

 

 

 

 

 

 

 

 

REFURBISHMENTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Transmission

Purchase Price

 

 

 

Mileage

 

 

 

Engine

 

Purchase Price

 

 

 

 

Mileage

Tires

Purchase Price

 

 

 

# of Tires

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Paint

 

Basic

Standard

 

Custom

Date Painted

 

 

 

 

Purchase Price

 

 

 

Interior

Purchase Price

 

 

 

Date

 

 

Leather

 

Vinyl

 

 

 

 

Cloth

Camper Shell

Purchase Price

 

 

 

Date

 

 

Carpet Kit

 

Purchase Price

 

 

 

 

Date

Special Wheels

Purchase Price

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other

Description

 

 

 

 

 

 

 

 

 

 

Purchase Price

 

 

 

 

Date

Restored

Restored Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Package/Special Features/Additional Options (XXXX=CALL BACK)

 

 

 

 

 

 

 

 

 

 

 

 

CONDITION RATING: Rate each of the following

0=Below Average, 1=Normal, 2=Above Average, 3=Exceptional

 

COMMENTS

Engine

 

0

 

1

2

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Transmission

 

0

 

1

2

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Paint

 

0

 

1

2

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Front Tires

 

0

 

1

2

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rear Tires

 

0

 

1

2

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Body/Glass

 

0

 

1

2

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Interior

 

0

 

1

2

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADJUSTMENTS

Pre Tax Adjustment 1

 

Add

Deduct

 

 

Pre Tax Adjustment 2

 

Add

 

Deduct

 

 

Sales Tax %

Leave blank if using AutoTax

Deductible

 

 

 

 

 

Post Tax Adjustment 1

 

Add

 

 

Deduct

 

 

 

Post Tax Adjustment 2

 

Add

 

 

Deduct

 

 

 

2

BCIF 01, CA

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2. Your next part is to complete all of the following blank fields: PS Power Steering PB Power Brakes, DécorConvenience, AC Air Conditioning DA Dual Air, CS Cloth Seats LS Leather Seats RL, Radio, AM AM Radio FM FM Radio ST Stereo, Controls, M Auxiliary Audio Connection EQ, Wheels, AW AluminumAlloy Wheels CJ Chrome, EG Electric Glass Roof ES Electric, SafetyBrakes AG Air Bag RG, RR LuggageRoof Rack WG Woodgrain, Other, and BD Running BoardSide Steps UP.

ccc basic claim information form writing process clarified (step 2)

3. The following section will be focused on AW AluminumAlloy Wheels CJ Chrome, XE Xenon Headlamps AR Bed Rails BL, and BCIF CA - fill in these fields.

Filling out section 3 in ccc basic claim information form

4. It is time to proceed to this fourth part! In this case you have all these CCC Valuescope Basic Claim, Claim Number, Office ID Number REFURBISHMENTS, Restored, Purchase Price Purchase Price, Purchase Price Purchase Price, Mileage of Tires Custom Date Date, Basic, Standard, Date Painted, Purchase Price, Engine, Purchase Price, Mileage, and Leather Carpet Kit fields to complete.

Part no. 4 of completing ccc basic claim information form

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