| Claim ID: | 16709 |
| Submitted: | Nov-19-2018 |
| Requested Processing: | Photos required |
| Name: | Kimsax |
| Email: | snstdr926@probbox.com |
| Company: | |
| Phone: | 82947814757 |
| Their Claim No.: | |
| Insured: | |
| Policy No.: | |
| Date of Loss: | 1977-10-12 |
| Insured Address: | Phoenix |
| Insured Telephone: | 89495646776 |
| Claimant Address: | Phoenix |
| Claimant Telephone: | 83581134984 |
| Loss Location | USA |
| Local Authorities: | |
| Loss Description: | albuterol |
| Handling Instructions: | albuterol |