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Office of Risk Management Catholic Diocese of Arlington 200 N. Glebe Road Suite 600 Arlington VA 22203 Phone 703-841-2503 General Liability Claim Form -Required Field Insured Name Diocese of Arlington Parish/School/Office Injured Individual s Name City Zip Code Person Reporting Date Form Completed MM/DD/YYYY Date of Incident MM/DD/YYYY Location of Incident Were there witnesses Yes No Please list Witness names and contact information Were the police or rescue squad called Yes No Police Report...
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