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League Name League I. D. Name of Injured Person/Claimant PART 1 SSN Date of Birth MM/DD/YY Age Sex Female Male Home Phone Inc. Area Code Bus. Accident coverage is underwritten by National Union Fire Insurance Company of Pittsburgh a Pennsylvania Insurance company with its principal place of business at 175 Water Street 18th Floor New York NY 10038. Be sure to include league name and league ID number. PART I - CLAIMANT OR PARENT S /GUARDIAN S IF CLAIMANT IS A MINOR The adult claimant or...

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Little League Baseball Amp is a form required to be filed by Little League organizations.

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