| Claim ID: | 17509 |
| Submitted: | Dec-01-2018 |
| Requested Processing: | Photos required |
| Name: | Janesax |
| Email: | maryjo1225@probbox.com |
| Company: | |
| Phone: | 81672749448 |
| Their Claim No.: | |
| Insured: | |
| Policy No.: | |
| Date of Loss: | 1977-12-10 |
| Insured Address: | San Jose |
| Insured Telephone: | 86695167857 |
| Claimant Address: | San Jose |
| Claimant Telephone: | 85564568215 |
| Loss Location | USA |
| Local Authorities: | |
| Loss Description: | valtrex 500 mg |
| Handling Instructions: | valtrex 500 mg |