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12
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1
Today's date
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Date
Day
Month
Year
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2
Name of scheme
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3
Street address of scheme
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4
Contact first name
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5
Contact surname
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6
Date 1
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7
name - addressee
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8
Contact phone
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9
Email
example@example.com
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10
Date of the loss or event
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Month
Year
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11
Please describe damages, causes, what happened, any further information or important details
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quote
Created with Sketch.
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12
Signed by
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13
Signature dated
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14
Signature
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15
Upload any pictures or information
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