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C.L.U.E.® Auto Claims Report

in Compliance with FACT Act

C.L.U.E. Reports Date Ordered: 05 / 11 / 2010 Expires On: 06/09/2010

C.L.U.E. AUTO CLAIMS REPORT

Reference #: 10531111940410 Date of Order: 05 / 11 / 2010
Account: 503272 LEXISNEXIS Date of Receipt: 05 / 11 / 2010
Recap: SUBJECT - 1 CLAIM(S) REPORTED
POSSIBLE RELATED CLAIMS - 0 CLAIM(S) REPORTED



SEARCH REQUEST
Subject Name: JOHN DOE
Date of Birth: 11 / XX / 19XX
SSN: XXX-XX-XXXX
Sex: U
Address: 123 S MAIN ST
ALPHARETTA, GA 30009-1911



REPORTED CLAIM HISTORY
The 7-year loss history below is associated with the subject and information listed in the Search Request section of this report. Additional loss history information may be available if additional search information is provided.
CLAIM 1
Claim Date/Age: 06 / 05 / 2006 (03yr - 11mo) CLUE File #: 1234567890123456
Company: GROUP INSURANCE INC Claim #: 1234567
Policy #: ABCD1234567890 Policy Type: PERSONAL AUTO
Policy Holder: DOE , JAMES W Vehicle Operator: DOE , JANE
Date of Birth: 11 / XX / 19XX
SSN: XXX-XX-XXXX
Sex: M
Address: 12345 PLEASANTDALE RD
ATLANTA, GA 30303
Drivers License #: 12345XXXX GA
Vehicle: JEEP LBRTYSPFRD
VIN: 1A2B3C4D5E6F7G8H9 Disposition: N/A
PAYMENTS BY CLAIM TYPE
Amount Type Status
$0 COLLISION CLOSED
$710 PHYSICAL/PROPERTY DAMAGE CLOSED
$0 RENTAL REIMBURSEMENT CLOSED
Additional Info: N/A



POSSIBLE RELATED CLAIMS
Claims listed below are based on a match of the subject's last name and the address(es) listed in the Search Request section of this report.
CLAIM 1
Claim Date/Age: 06 / 05 / 2003 (06yr - 11mo) CLUE File #: 1234567890123456
Company: GROUP INSURANCE INC Claim #: 7654321
Policy #: ABCD1234567890 Policy Type: PERSONAL AUTO
Policy Holder: DOE , JAMES W Vehicle Operator: DOE , JANE
Date of Birth: 11 / XX / 19XX
SSN: XXX-XX-XXXX
Sex: M
Address: 12345 PLEASANTDALE RD
ATLANTA, GA 30303
Drivers License #: 12345XXXX GA
Vehicle: JEEP LBRTYSPFRD
VIN: 1A2B3C4D5E6F7G8H9 Disposition: N/A
PAYMENTS BY CLAIM TYPE
Amount Type Status
$7,000 COLLISION CLOSED
$50 RENTAL REIMBURSEMENT CLOSED
Additional Info: N/A



INQUIRY HISTORY
Date: 11 / 22 / 2009 Requestor: FACTACT/CHOICEPOINT
Date: 04 / 01 / 2010 Requestor: FACTACT/CHOICEPOINT



Prepared by: COMPREHENSIVE LOSS UNDERWRITING EXCHANGE
C.L.U.E. Inc., Atlanta, GA.
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