Chain of custody form — Fillable 2026

EVIDENCE CHAIN-OF- CUSTODY TRACKING FORM Claim Number: __________________ Other Reference Number: __________________ Vehicle Identification Number: ____________________________________________ Vehicle Year: ___________ Make: __________________ Model: __________________ Requested By (Name & Company): _____________________________________________ Email Report to: _______________________________________________________ Location of Retrieval: ___________________________________________________ Name: ____________________________________________________________________ Postal Address: _____________________________________________________________ Name and Address of Person who Handled Evidence (required by ASTM E1188-95): Signature: Chain of Custody Item # Date/Time Released by (Name & Address) Received by (Name & Address) www.collision-sciences.com 1 (877) 363-1996 Copyright 2020 ASTM: E 1188-95. Standard Practice for Collection and Preservation of Information and Physical Items by a Technical Investigator. Description of Evidence Item # Quantity Description of Item (Model, Serial #, Condition, Marks, Scratches) SIGN 1 1 Event Data Recorder (airbag module). Silver Box. Demarcated with the last six digits of the VIN. 1 Brian Hsu 172 Tierra Ave Maple, ON L6A 3H7, Canada

Final Disposal/ Release Authority www.collision-sciences.com 1 (877) 363-1996 Copyright 2020 ASTM: E 1188-95. Standard Practice for Collection and Preservation of Information and Physical Items by a Technical Investigator. Item(s) on this document is (are) no longer needed as evidence and is/are authorized for disposal by (check appropriate disposal method) Return to Owner Destroy/Divert Name of Authorizing Person: ______________________________________________ Signature: __________________________ Date: ________________ Authorization for Disposal or Release Item(s) #: _______ on this document were destroyed by Evidence Custodian _______________ in my presence on (date) ______________. Name of Witness to destruction: ________________________________________________ Signature: __________________________ Date: ________________ Witness to Destruction of Evidence Item(s) #: _______ on this document was/were released by Evidence Custodian _____________ to Name: ____________________________________________________________________ Postal Address: _____________________________________________________________ I certify that I am the lawful owner of the above item(s). Signature: __________________________ Date: ________________ Release to Lawful Owner This Evidence Chain-of-Custody form will be retained as a permanent record by Collision Sciences. SHIPPING INSTRUCTIONS: Write the last 6 digits of the VIN using a permanent marker on any vehicle module (EDR). Please ship the module, using "Signature Required" delivery instructions to: SIGN SIGN SIGN Collision Sciences, Attention: Brian Hsu 172 Tierra Ave Maple, ON L6A 3H7, Canada If the Return to Owner option is selected, please include a return shipping label in the package, or contact Collision Sciences at service@collisionsciences.ca to discuss costs. For Event Data Recorders, once the data is forensically imaged, the module is no longer required, and would only be recommended to be preserved if litigation is anticipated or underway.