Claim ID: 17668
Submitted: Dec-03-2018
Requested Processing: Photos required
Name: Evasax
Email: angle@probbox.com
Company: google
Phone: 85635459475
Their Claim No.:
Insured:
Policy No.:
Date of Loss: 1978-10-10
Insured Address: New York
Insured Telephone: 85631794432
Claimant Address: New York
Claimant Telephone: 87734292629
Loss Location
USA
Local Authorities:
Loss Description: accutane 40 mg
Handling Instructions: accutane 40 mg