Claim ID: 19696
Submitted: Jan-01-2019
Requested Processing: Photos required
Name: Evasax
Email: homers111@probbox.com
Company: google
Phone: 84786135531
Their Claim No.:
Insured:
Policy No.:
Date of Loss: 1976-10-10
Insured Address: New York
Insured Telephone: 85566858186
Claimant Address: New York
Claimant Telephone: 85561583731
Loss Location
USA
Local Authorities:
Loss Description: ventolin 90 mcg
Handling Instructions: ventolin 90 mcg