Front:
Form 3820 7-11-21
Nof6383
Claim No:
192
Dageniefuintutt.li tamhut
Employer
Employe
ma.
no.
Is emptoye able to work
281921
If so, from what date ?
If not when will he probably be able to work?.
PHILA. CLAIM DEPT.
Cugeri Raimtaultimploper
Back:
OCT
EPLY CAR
REPL
MARTY. WASHINGTON
(THIS SIDE OF CARD IS FOR ADDRESS
London Guarantee & Accident Co., Ltd.
434 WALNUT STREET
PHILADELPHIA, PA.
Claim Dept.
