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Property Claims Report

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C.L.U.E.® Property 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. PROPERTY CLAIMS REPORT

Reference #: 10531111952674 Date of Order: 05 / 11 / 2010
Account: 503285 LEXISNEXIS Date of Receipt: 05 / 11 / 2010
Recap: RISK - 2 CLAIM(S) REPORTED
SUBJECT - 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
Telephone #: (123) 456-7890



REPORTED CLAIM HISTORY FOR RISK
The loss history below is associated with the subject and risk address 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: 04 / 23 / 2009 (01yr - 00mo) CLUE File #: 1234567890123456
Company: GENERAL INSURANCE INC AM BEST #: 12345
Policy #: 123456789 Policy Type: HOMEOWNERS
Claim #: 123456789012 Additional Info: CATASTROPHE
Address: 123 S MAIN ST
ALPHARETTA, GA 30009-1911
PAYMENTS BY CLAIM TYPE
Amount Type Status
$1,287 Wind CLOSED
CLAIM 2
Claim Date/Age: 09 / 28 / 2006 (03yr - 07mo) CLUE File #: 6543210987654321
Company: GENERAL FIRE INS AM BEST #: 12345
Policy #: 1X2Y3Z4F5G6H7J8K9X Policy Type: HOMEOWNERS
Claim #: ABC1234567 Additional Info: On Premises
Address: 123 S MAIN ST
ALPHARETTA, GA 30009-1911
PAYMENTS BY CLAIM TYPE
Amount Type Status
$4,127 Lightning CLOSED



REPORTED CLAIM HISTORY FOR SUBJECT
The reported loss history below is associated with the subject, either at the risk address or at other developed addresses.
CLAIM 1
Claim Date/Age: 04 / 23 / 2007 (03yr - 00mo) CLUE File #: 1234567890123456
Company: GENERAL INSURANCE INC AM BEST #: 12345
Policy #: 123456789 Policy Type: HOMEOWNERS
Claim #: 123456789012 Additional Info: CATASTROPHE
Address: 123 S MAIN ST
ALPHARETTA, GA 30009-1911
PAYMENTS BY CLAIM TYPE
Amount Type Status
$5,999 Tree CLOSED
CLAIM 2
Claim Date/Age: 09 / 28 / 2005 (04yr - 07mo) CLUE File #: 6543210987654321
Company: GENERAL FIRE INS AM BEST #: 12345
Policy #: 1X2Y3Z4F5G6H7J8K9X Policy Type: HOMEOWNERS
Claim #: ABC1234567 Additional Info: On Premises
Address: 123 S MAIN ST
ALPHARETTA, GA 30009-1911
PAYMENTS BY CLAIM TYPE
Amount Type Status
$1,127 Hail CLOSED



INQUIRY HISTORY
Date: 01 / 08 / 2009 Requestor: UNITED SERVICES AUTO ASSN
Date: 05 / 11 / 2010 Requestor: FACTACT/CHOICEOINT



Prepared by: COMPREHENSIVE LOSS UNDERWRITING EXCHANGE
C.L.U.E. Inc., Atlanta, GA.
"C.L.U.E." is a registered trademark of LexisNexis Risk Solutions Inc.