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FAILURE TO DO SO MAY RESULT IN A REDUCTION OF THE AMOUNT PAYABLE ON YOUR CLAIM. Keep a copy of this form for your records receipted and dated by the claims office. If more than one page is needed please number the pages. SECTION A - To be completed by member 1. STATEMENT OF PROPERTY LOSS OR DAMAGE You are hereby notified of the loss or damage in the following shipment of personal property. a* Name of Member Last First Middle Initial b. PPGBL/Order Number c* Date of Delivery d. Origin of Shipmen ...

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