vv I rt-tt6HoiIH.fi#&*+i t o)P rry-r rcrL\<1.

Sfi&&4EE# LAfrUXf A. (AIEr*ffii3* i't*f " )t .'Z'*'c' t- lc b $r fi,ffi tc ir{zi.i- ( /d* v\" (BaEEoiE-#rrB+;Etffi*n-BlEgI fa. B 6FE o iE aR lt ffi f+ -e

5fi'efr>->tcD fErrB c ( 4A4rE /e r,./r LFfiffinrb
D *. Lta b t*c t g "l don't understand your Japanese.
Could you please switch to another Japanese lnterpreter?"t'EiL< ( /d * t,'' )b . Sfito#frHt 8 i'&t f ii, B +A{Hffi /affiffi /a fr t, r
El Litlffii, 6 X 5 ttcU< < t'3 r,." -/d l,E,V.*f. tt,.i I if*.*fr,t *iL*f L. itcB DH,R-(r,r/*Lrl+Uffi* it, 4HSoEt,.ilt€+R* tLa . t r,) b D *.-f "c.

itfr L ic I v.Sf&o##flitffi+EXtc L( $Ml-t,./c/dL\(6frfLr*.rllr"vv,t1*atLfr-ebD. *H

H< i, *L {W&.I."4fi{l L : /. /d t,. ( *s D * f fi 6rr t o *. *. v y I fi *tlc$&'fr L*f" *jElft&L I I v 2 o u-Haul P*+ vv v )"tt*#*.
NHa t t v v, )v * tL 6 &A &ft*.91 t" rs 9 * f o <., **s-H v
v I h - 3 tL 6 ffi rc i*,1' f {xFA 6 -ffi tc t *#! ( /d * v." *ffiH.t v
z g h ** *16H. E+t< f.. 2 4,r- I z l- lc i4ffijv.t#vr(',>6fio\*t*.t fel *.t. *rEffi.DH$s.RFfr<v v I )t -t d tL6ffi. Cts rI&$r * tuSfitrrftg * ( {, H l*F> D *. t A, ot< ;. 6 6 $citH ( /i * r,.. v y, rt - tiBrr * lL 6w€^ tt. v v g )t -attlc<EFHtlc t-74,r*Hffirtr,il'*t t* D *f" ffffi**u<t,./rv'f t*rE
4E * tr&{r& I i ciIH ( /d * r,'",&#fft tt v y B fi - *tlrt' b 3'>o{*[Atffi#3 tr*f.
iffiI ) HHtr{+H (r-iauitity) 2 ) Effi{*H (personataccident lnsurance .
Medical) 3) SttWt

vnrt*ffiff (DamageWaiver){, L 6 aHqofrEDXr*ofr:,d< X 4 L rr{rtf, Z 0)t *.0>ffitHfrdlttvv I fi-lc&'fr\^t L*f" Sffi{*&rrl*v'EA{t vv, t1E{tlc*19516fHit/*t,. $o)L*s4t- ( /d* r,'" Hffi{*pftf collision) tbffibostr6<$. ftHAE(Deductibre) * <"tt H EAfl[ ] lt 0 *.t. Effi{*fH {, H*A@*Rfft(comprehensived. aE HCIt&X.glt/sr,' LB,htL6$ffitczv,(it.

ltc * D t . b b{H|Jisffiv. L,B.i?/arzrffipfu t L.> fi, D E

i-. flfH 6EX,EE

L< < /dt r,."t#rE L(r,,/c/d ( E"eicffiffi2r6 9* f ,r, 4 Olfrt.ffi+g* tcU<H,i-(t,. A. t. {8,i.
/cr,.C L. HffiiF -t*.t a><$rt,fr,6 L J.L)("L re. S&4&EE.\Ai,f,'I*, 1 /s D *'f . 1frffitc',fr rt,tu 6[fr lc lt H BiJHSfttrsHv
tr<"b a c t tl**-. ffiFftfarlrclxw*1*.0> ? v ^i,,{-t*iitff L ( t'* r,," < i -f 6 c t tc X D, ffi[ftr'b6#{*Fft*it rcffi *B a)X{t L < < *r & f "* iEl Ho>WfrfrL ?*!&ry,6. ffi6 D o Ursent Care t
Walk-in Clinic lc'tt <,*'l8fi+rffi4ilLr.L.r,']aAl* Bn --fT ( ,EmergencyRoom tc'frrt'il,* r'r EffiHAEitr,cts D *:f CI<', ffifr I o 2 r) = v, t t A fft b HX b *r, ( t,' < fr fitl+ b ffi Ffi # z}. /c v . :ltifl, <"!"$&ffiffl$=r.r=Ttv

f Medical Payments) t*rftb t/4 t,rffi611

vv, rt -oiBffi+SfiftliiHr/,fa+iA 3 *l< 6f*Hl*##.t-*.*Lo)<c'iIH ( #3 v,"3) offiffit vv I fi-a+trffi 3 tv*.-r L, vv t r-rrs*krcb">tcw,, vv, /1-HW1>ffiEt rrl,r<- HEHElze < aiE*tlL(f " 3 ) offiffi'& v v R )t - a+t(.ffi^ * ir,/* v'i#611,v v I /t -rs+Ffitlc$&klciBt,r, MWW1A+E#*.'f 6 v v t )t -*r,' /a /i rl *?L0> 6r151pqRH,iSffifirrb 6E6. tt. [El*AffiHRW (Personal Injury
Protection 6 L ( it Medical payments o{XHrl6fLix*.

'lEfio{.,iifi,}cL I D *frl.

(Personal lnjury ProtectionMHHlnsurqnce*j#ffi lc FH* g ix 6 . t rt\ b I), . o fiih oH,H

l*6FAAt*?'?*fAbiti ; r r*P ?_-Bg-,a:?_"e,, fEH < Iia ul"*.tc. vv t )t-Att< rfi,b 310>ffiH?-ffi-)',3ttr,ct*h. {*B*+1/1,bl)aBt*-flls ( , {15F qcE € r."n *Jo<". .iIH ( /d8v.. zyl 9 yl*.),.-t(L:AL c-b*.<^t1,< CiE*lt( /dtr,."Contact Us
MHH lnsurance Agency
16000 Bothell-Everett Hwy Suite 162
Mill Creek, WA 98012

206-7ss-5s8s I 888-391-s0ss
Visit us on the Web:www.mhhinsurance.com
MHH lnsurance

1.

2.
3.

6 L {, o$fiftffioffirfilc?vr(F,tw,b€$ b"fH( <Hr' bft L'rH I f. H D tc$-ffi9;ry*.Ltc. ttE*-bfctb icz''f- F ' 7 v/'_fr.ffi,t t' :E+Ff&.* #c t /*v. I i. ilH L<|1WJb t A Xi,L'rri,* L r i"rjlrf /i1 r 6 rAA H* f*{€.H tr*"H. Lqr r
s#^iBf6 L, sfrkifiHfrh L( +r b i " (* <;lErfoth&4) lElffi" ) iiH: Hffi/r*/crhb, H+rt+tffi,tffifH* tL*,-f " Lel1
lffi +r' b $ b c tc%ffi L €-;fi#+rrffi D fi c te )sf.& E :ffi.Ffiffi :,hFfi t itFfi : GHWabBA t*S&trsE E /crHfi& L *6iEr,' Cross Street&)Xt4 r iEffiatltf,E :Police Department:
Case Number:f14.,s'o>*,&:

rffi + or&ft s&ft /d "> tc D tc,'th.frtH +fi|l Bi&tr a Ery.

Hf€ :e)hfi,-:fe) txl'L r,,->tel -xl*I ( A D *.t" <0) L i /ISHS X&.V 6 fcxb ic 6 . :Ffikrrfrg. c lc bH
ffiAry6t, #fift-drIEfitL< 6 b i c t **sff rDu,/c

fH#.btir{:

L *f" #*rt,b Exchange Report S Case#& 6 bt,.
* L r i"4.

#ffi olH# : ( * ( itb rf(tE+-ruE i/ a. L *. "> rzw* $ wN t w /.(. < /d t r,. o ){E+{EIIL d'ElrlHW.tXW-f 6 "F 7 4,,t- *r I r,xlE*#o &Ht . EFn . €fi6#8.

I-.

f *Dl*w*+*e .€-E-fr#B . -ir##B .E*jt-/,r v | & .ffi*o>Hl>7>-l,y,s- .#otffi
74

Sffio#*fi :Ib ba]tEl*.<f rt'?
trWACIFt,A r €ifr*€ :H*#o>*,At *.fBF. :ffi.+rt .&rt I"A+E+{H||Lt&L*f" /a*s, ,fE*

#tft6 ffi i*. Wffi/s#Eic$fr,A{rf rl ( /i t v,.
a H 4 o;Eft ('E L z /cEFftftr fs\'t*h, fr&-e ttffi
4"t:"Hff"?=$:v_!s"!*,"-H.ffi til.l".y"tu!:2","fr 2kDL<iit,'l/tt/u.

5. L)?. U. 'e, f a X i frIF&/lE * tcDi'. !Feft:tr
tno1effitry.a,{*Ffi*tt lc iE+E f 6 f# rc,B'W c ts. 6 o'e. }Ffrt /sftd ctz /cffiffi . WFfi ' rHffio€HtSAEdffi L * L r i"

6. E*#*rr,, 6wbtt&HtL €ffiffiq.2ffir,,<*s ( "7. Eilroo-5Htffi,6. t1*afur-fEfi, {ftPftFfl, Sfifto*E*jt++ti*6 0 *.-tfi,? :tE*o{H# :ffi*aF74,t*o>*,*:€ffi6€:.{iBt :
iE*rfr;if-ifil Y,s* t #11i'll :Insurance Company

tE+CIHffiSe, :E*rh-rfi 0>€F-btftffi€ffi<'ffi : ( *j ( r ) lc L * L

/v*

I i.

frHotEH:ltifi, :8. {frtrfrA+t+:r*J:r z I.ic$&t+Rffitf 6. #WWIE
i'b Insurance ID , - l''' lcFdffi * it,( t,' 6 Claim =#l. *r€;fr I trL( 1, ffi v. t tl/,,"./+:

l.

* vrs-I Policy# :-rx F t€ffi#g: