London Guarantee & Accident Co., Ltd. Claim Card

Front:
Form 3820 7-11-21 Claim No. 58457 192 8-22-24 Vattieri & Pontarelli Dominic Barboni-8-1-24 Yet Employer Employe Lushaihepaut Today at Is employe able to work? Augh sae If so, from what date? rdined If not, when will he probably be able to work ? 28 104 Valherofomtaslle. Employer

Back:
DOSA AUG 27 - G.P. O. ANNEXE G.P.O.AN I 230 PM XOARD REPRO MARTHA WASHINGTON (THIS SIDE OF CARD IS FOR ADDRESS London Guarantee & Accident Co., Ltd. 434 WALNUT STREET Claim Dept. PHILADELPHIA, PA.