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SAMPLE SUBRO INITIATIVE

ROBERT JONES
JONES INSURANCE GROUP
111 W 6TH AVENUE
ANYWHERE, CO 80021
CLIENT #:         A0345
LOSS DATE:     1/11/98
CLAIM/ACCT:  000000123
REFERENCE:    SUE JOHNSON

We have developed the following information:

SUBJECT:
ADDRESS:

JOHN M. SMITH
543 SKIPTOWN AVENUE,
ALLENTOWN, PA 80202
(211) 222-9998

COUNTY:
GENDER:
DATE OF BIRTH:
SOCIAL SECURITY NUMBER:
DRIVERS LICENSE:

LINCOLN
MALE
1/13/65
111-22-3232
26-343-4497

REAL ESTATE OWNERSHIP:
LEGAL DESCRIPTION:
AREA WEALTH RATING:
PURCHASE DATE:
ASSESSED VALUE:

YES, ABOVE ADDRESS
LOT 21A, MAP4
UPPER-MIDDLE
6/15/92
$97,000.00
EMPLOYER: WOODS CONSTRUCTION
326 N. PINE, SUITE #1246
ALLENTOWN, PA 80202
(211) 675-1553
POSITION:
DOH:
CARPENTER
7/1/97

Per your surbo-initiative request insurance coverage was identified with Everson Insurance Group in Allentown, policy number 233-33-233.

FEE: $XX.00 CASE#: 20000112-I2 (Please refer to case # when remitting)

This investigation was conducted in compliance with the
Fair Credit Reporting Act and the Gramm-Leach-Bliley Act.



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