| Claim ID: | 16502 |
| Submitted: | Nov-16-2018 |
| Requested Processing: | Photos required |
| Name: | Nicksax |
| Email: | hcniner09@probbox.com |
| Company: | |
| Phone: | 81167152493 |
| Their Claim No.: | |
| Insured: | |
| Policy No.: | |
| Date of Loss: | 1977-12-12 |
| Insured Address: | New York |
| Insured Telephone: | 86942479481 |
| Claimant Address: | New York |
| Claimant Telephone: | 82634952613 |
| Loss Location | USA |
| Local Authorities: | |
| Loss Description: | ventolin inhaler cialis prednisone albuterol drug lasix |
| Handling Instructions: | ventolin inhaler cialis prednisone albuterol drug lasix |