| Claim ID: | 16776 |
| Submitted: | Nov-20-2018 |
| Requested Processing: | Photos required |
| Name: | Online Payday Loan |
| Email: | cobumaas@pochtar.men |
| Company: | |
| Phone: | 81751651327 |
| Their Claim No.: | |
| Insured: | |
| Policy No.: | |
| Date of Loss: | 1978-12-10 |
| Insured Address: | Dallas |
| Insured Telephone: | 82996835847 |
| Claimant Address: | Dallas |
| Claimant Telephone: | 85186248836 |
| Loss Location | Dallas--winston USA |
| Local Authorities: | |
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