Loss Prevention Form

Store (required)
BolehallChurch StreetDordonDosthillGlascoteKingsburyLichfieldPolesworthRoslistonStrettonWhittingtonWood End

Date of Incident (required)

Time of Incident (required)

Brief Description of Offender(s) (required)

Picture(s) of Offenders

Name of Offender(s) (if known)

Items Taken (required)

Police Crime Reference (if known)

CCTV Footage Requested by Police? (required)
YesNo

Any other details (eg date Police require CCTV by)?