| Claim ID: | 16866 |
| Submitted: | Nov-21-2018 |
| Requested Processing: | Photos required |
| Name: | Samsax |
| Email: | rmendonsa@probbox.com |
| Company: | |
| Phone: | 89633632557 |
| Their Claim No.: | |
| Insured: | |
| Policy No.: | |
| Date of Loss: | 1975-12-11 |
| Insured Address: | New York |
| Insured Telephone: | 85784942973 |
| Claimant Address: | New York |
| Claimant Telephone: | 83758116952 |
| Loss Location | USA |
| Local Authorities: | |
| Loss Description: | doxycycline amoxicillin lisinopril diuretic acyclovir 400mg tablets buy prednisolone 5mg |
| Handling Instructions: | doxycycline amoxicillin lisinopril diuretic acyclovir 400mg tablets buy prednisolone 5mg |