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3600.XXX
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Text File
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1991-06-27
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558b
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19 lines
#3600
@001 Enter the name of the insurance company:
@002 Enter the name of the insured:
@360/@360/@360/@360 Enter nature of peril resulting in claim:
Automobile collision
Fire
Theft
KEY IN VALUE
@361/@361/@361 Enter the type of coverage claim was paid under:
Automobile Collision/Comprehensive
Homeowner's
KEY IN VALUE
!362 Enter the amount of the claim in numerals:
!363 Enter the amount of the insured's deductible in numerals:
#3601/#3602 The insured's deductible:
Will be collected by the insuror
Will be retained by the insured
#3603