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The document is a Loss & Damage Claim Form for hearing instruments, requiring information from the claimant and dispenser, including details about the lost or damaged hearing aid. It includes sections for personal information, description of the incident, and certification by a notary. The form also notes that replaced instruments become Unitron's property and outlines the nonrefundable processing fee.

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Versions	Form popularity	Fillable & printable
2017	5 Satisfied (28 Votes)
2014	4.3 Satisfied (70 Votes)

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