--- type: court_doc id: "court_ctb_1787_19" court: "CTB" case_no: "22-50073" doc_number: 1787 doc_type: "UNKNOWN" filed_date: null lang: "zh" url: "https://mubeitech.com/court/court_ctb_1787_19" json_url: "https://mubeitech.com/api/court/court_ctb_1787_19" --- # | Form recommendod by the | | |-------------------------------------|--| > 原始法庭文件为英文；下方为英文全文，顶部为中文摘要。 | Form recommendod by the | | |-------------------------------------|--| | National Board of Fire Underwriters | | | July 1950 | | ### PARTIAL SWORN STATEMENT IN PROOF OF LOSS | 528,194,359.00 ADDITIONS &
ALTERATIONS | | 0061821440 | |------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------|-----------------------------------| | AMOUNT OF POLICY AT TIME OF LOSS
3/6/2023 | | POLICY NUMBER
NYNY | | DATE ISSUED | | AGENCY AT | | 3/6/2024 | | Wolfson Insurance Brokerage, Inc. | | DATE EXPRES | | AGENT | | To the
AIG Private Client | | | | of | | | | At the line of loss, by the above indicated policy of insural Genever Holdings LLC c/o Luc A. Despins Chapter 11 Trustee i | Ho Wan Kwok | | | against loss by
Fire | to the property described under Schedule "A" according to the terms | | | and conditions of the said policy and all forms, endorsements, transfers and assignments attached thereto. | | | | 1. Time and Origin: A Fire | loss occurred about the hour of a course in
o'clock | | | STATE LOSS | | | | on the 15th 15th
day of March | 20 23 The cause and origin of the said loss were (state all known facts | | | - attach separate sheet if necessary) | | | | 3. Title and Interest: At the line of the interest of your insured in the property described herein was were | No other person or person or persons had any interest therein or | | | encumbrance thereon except (state liens/mortgages/encumbrances, if any) None | | | | 4. Changes: Since the said policy was issued there has been no assignment thereof, or change of interest, use, occupancy,
possession, location or exposure of the property described except. NONE | | | | 5. Total insurance: The total amount of insurance upon the property described by this policy was at the lime of the loss.
28, 194, 359.00, ADDITIONS & as more particularly specified in the apportionment attached under Schedule "C" bestdes which
ALTERATIONS | | | | there was no policy or other contract of insurance written or oral valid or invalid. | | | | 6. The Actual Cash Value of said property at the time of the loss was | | | | 7. The Whole Loss and Damage was | | 391,047.97 | | 8. The Amount Claimed under the above numbered policy is See Schedule B PARTIAL \$ | | 391 047 97 | The said loss did not orginate by any act or procurement on the part of your insured or this affiant; nothing has been done by or with the privily or consent of your insured or this affiant, to violate the conditions of the policy, or render it void: no articles are mentioned hereir or in annexed schedules by such as were destroyed or damaged at the lime of said has in any manner been conceale and no attempt to deceive said company, as to the extent of said loss, has in any manner been made. Any other information that may be required will be furnished and considered a part of this proof. The furnishing of this blank or the preparation of the above insurance company is not a waiver of any of its rights. \* This NOTICE is required by Reg. 95, Art IIIB, of the NYS Insurance Law. Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and shall be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. | Car | | | | Genever Holdings LLC clo Luc A.
Despins Chapter 11 Trustee of Ho Wan
KWOK 33868688824 | |-------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------|-----|---------------------------------------------------------------------------------------------| | State of | (Signature) | | (X) | | | County of Incles and Career ISCands | (Print) | | | | | Subscribed and sworn to before me this - 216 - day of | 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 | 2023 | | | | AAG Ltd Genever Proof (pg. 1) 10/15/97 | | | | PUBL | | | | | | | | | | | | | 2 ## SCHEDULE "A'— POLICY FORM (complete this section or attach full copy of policy / policies) | P
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