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165 Yes / No If yes submit form SVC within 15 days after filing the Application for Resolution of Claim. Attestations I understand that any person who knowingly and with intent to defraud any insurance company or other person files a statement or claim containing any materially false information or conceals for the purpose of misleading information concerning any fact material thereto commits a fraudulent insurance act which is a crime. Application for Resolution of a Claim Injury October...
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