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Com BAP 272914 PART I POLICYHOLDER S REPORT 1. Claimant s Name injured/ill person 2. Social Security Number 3. In addition an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant. School District DENTON ISD School Name P. O. Box 117558 Carrollton Texas 75011-7558 Phone 972 512-5600 Fax 972 512-5818 Toll Free 866 409-5734 STUDENT CLAIM FORM 1. Please fully complete this form 2. Attach itemized bills 3. Mail E-mail or Fax to HSR...
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