| Claim ID: | 16995 |
| Submitted: | Nov-23-2018 |
| Requested Processing: | Photos required |
| Name: | Miasax |
| Email: | diannej12@probbox.com |
| Company: | |
| Phone: | 81888954281 |
| Their Claim No.: | |
| Insured: | |
| Policy No.: | |
| Date of Loss: | 1977-10-10 |
| Insured Address: | San Jose |
| Insured Telephone: | 85679515721 |
| Claimant Address: | San Jose |
| Claimant Telephone: | 87233196595 |
| Loss Location | USA |
| Local Authorities: | |
| Loss Description: | doxycycline hyclate 100 mg capsules prednisolone lisinopril amoxicillin 500 mg acyclovir |
| Handling Instructions: | doxycycline hyclate 100 mg capsules prednisolone lisinopril amoxicillin 500 mg acyclovir |