| Claim ID: | 16945 |
| Submitted: | Nov-23-2018 |
| Requested Processing: | Photos required |
| Name: | Jacksax |
| Email: | raidon1@probbox.com |
| Company: | |
| Phone: | 87246292828 |
| Their Claim No.: | |
| Insured: | |
| Policy No.: | |
| Date of Loss: | 1979-12-10 |
| Insured Address: | Phoenix |
| Insured Telephone: | 88389176814 |
| Claimant Address: | Phoenix |
| Claimant Telephone: | 85296763483 |
| Loss Location | USA |
| Local Authorities: | |
| Loss Description: | doxycycline acyclovir amoxicillin 500 mg no prescription lisinopril prednisolone sod |
| Handling Instructions: | doxycycline acyclovir amoxicillin 500 mg no prescription lisinopril prednisolone sod |