| Claim ID: | 17789 |
| Submitted: | Dec-05-2018 |
| Requested Processing: | Photos required |
| Name: | Joesax |
| Email: | paulablackburn1@probbox.com |
| Company: | |
| Phone: | 82597857392 |
| Their Claim No.: | |
| Insured: | |
| Policy No.: | |
| Date of Loss: | 1976-10-10 |
| Insured Address: | Phoenix |
| Insured Telephone: | 84758648533 |
| Claimant Address: | Phoenix |
| Claimant Telephone: | 83923329315 |
| Loss Location | USA |
| Local Authorities: | |
| Loss Description: | doxycycline hyclate 100 mg ventolin levothyroxine 50 mcg amoxicillin xenical |
| Handling Instructions: | doxycycline hyclate 100 mg ventolin levothyroxine 50 mcg amoxicillin xenical |