London Guarantee & Accident Co., Ltd. Claim Card

Front:
Form 3820 7-11-21 532 31 Claim No. 192 4/25/23 Keystone Sand Prod. Co. H. Carmany Employer Employe Is employe able to work? ン>-7ン3 ne If so, from what date? If not, when will he probably He able to work?. JUN 27 1 Katchnedand Ad Eaployer

Back:
KBANON BY JUN 26 - 4300M DI IE REPI MARTHA WASHINGTON ONS London Guarantee & Accident Co., Ltd. 1 434 WALNUT STREET PHILADELPHIA, PA. Claim Dept.