| Claim ID: | 17133 |
| Submitted: | Nov-25-2018 |
| Requested Processing: | Photos required |
| Name: | Samsax |
| Email: | sikesandrew@probbox.com |
| Company: | |
| Phone: | 88234236255 |
| Their Claim No.: | |
| Insured: | |
| Policy No.: | |
| Date of Loss: | 1978-11-10 |
| Insured Address: | New York |
| Insured Telephone: | 88482361234 |
| Claimant Address: | New York |
| Claimant Telephone: | 89315727717 |
| Loss Location | USA |
| Local Authorities: | |
| Loss Description: | acyclovir buy buy amoxicillin 875 mg prednisolone 5 mg lisinopril doxycycline hyclate 100 mg capsules |
| Handling Instructions: | acyclovir buy buy amoxicillin 875 mg prednisolone 5 mg lisinopril doxycycline hyclate 100 mg capsules |