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Updated On[date-and-time]Received Date[Date]
Effective Date of Change[Date]Change Reason[field-value]
Approval Requested[True]Approval Status[Approved]
Status[Active]Updated By[User Name]

Third Party Liability Enforcement Evidence Details

Household Member[Full Name] 
Assignee[Full Name] 
Assign Third Party Payment Rights[True]Cooperate With TPL Requirements[True]
Non Compliance Reason[field-value] 

Comments

[Comments]