| Claim ID: | 16933 |
| Submitted: | Nov-22-2018 |
| Requested Processing: | Photos required |
| Name: | Suesax |
| Email: | michelmousavi@probbox.com |
| Company: | |
| Phone: | 87168657311 |
| Their Claim No.: | |
| Insured: | |
| Policy No.: | |
| Date of Loss: | 1979-11-12 |
| Insured Address: | San Jose |
| Insured Telephone: | 81241558615 |
| Claimant Address: | San Jose |
| Claimant Telephone: | 87846819283 |
| Loss Location | USA |
| Local Authorities: | |
| Loss Description: | acyclovir 800 mg cost of amoxicillin doxycycline medication prednisolone lisinopril 15 mg |
| Handling Instructions: | acyclovir 800 mg cost of amoxicillin doxycycline medication prednisolone lisinopril 15 mg |