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Baggage DelayLoss Claim Form ITravelInsured 2020-2023
Country and unit BENEFICIARY RECIPIENT INFORMATION Name Address shown on your bank account no P. O. Box SWIFT Code Required for international payments Required if sending Euros BENEFICIARY BANK RECIPIENT BANK INFORMATION Bank Name Branch address linked to your account Account Number ACH Routing Number INTERMEDIARY BANK INFORMATION if applicable SPECIAL INSTRUCTIONS i.e. If 100 of the benefits owed should not be transferred to the above Beneficiary bank REQUESTOR AUTHORIZATION By signing...
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