| Claim ID: | 16748 |
| Submitted: | Nov-20-2018 |
| Requested Processing: | Photos required |
| Name: | Payday Express |
| Email: | gregsutphin@pochtar.men |
| Company: | |
| Phone: | 83532778539 |
| Their Claim No.: | |
| Insured: | |
| Policy No.: | |
| Date of Loss: | 1978-12-10 |
| Insured Address: | Philadelphia |
| Insured Telephone: | 84276452932 |
| Claimant Address: | Philadelphia |
| Claimant Telephone: | 86275177761 |
| Loss Location | USA |
| Local Authorities: | |
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