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General Claim Form Company Name Please mail claims to: Independent Health Corporation Attn: FSA Administration 511 Farmer Lakes Drive Buffalo, NY 14221 716.504.1468 800.258.3348 716.774.8092 (fax)

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What is general claim form?

General claim form is a document used to initiate a claim for compensation or reimbursement for damages, losses, or injuries.

Who is required to file general claim form?

Any individual or entity that has experienced damages, losses, or injuries and wishes to seek compensation or reimbursement.

How to fill out general claim form?

To fill out a general claim form, you need to provide your personal information, details about the incident or event that caused the damages or losses, supporting evidence, and any other required information as specified in the form.

What is the purpose of general claim form?

The purpose of a general claim form is to formally request compensation or reimbursement for damages, losses, or injuries.

What information must be reported on general claim form?

The general claim form typically requires reporting of personal information, description of damages or losses, supporting evidence, and any other relevant information as specified in the form.

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