| Claim ID: | 17827 |
| Submitted: | Dec-06-2018 |
| Requested Processing: | Photos required |
| Name: | Janesax |
| Email: | catherine77@probbox.com |
| Company: | |
| Phone: | 81985142898 |
| Their Claim No.: | |
| Insured: | |
| Policy No.: | |
| Date of Loss: | 1979-10-10 |
| Insured Address: | San Jose |
| Insured Telephone: | 87148948124 |
| Claimant Address: | San Jose |
| Claimant Telephone: | 82714781953 |
| Loss Location | USA |
| Local Authorities: | |
| Loss Description: | albendazole tablets 400 mg |
| Handling Instructions: | albendazole tablets 400 mg |