MUBEITECH

Guo Wengui / Miles Guo — bankruptcy case · ECF #1787-19

METADATA

Defendant
Guo Wengui / Miles Guo / Ho Wan Kwok
Court
CTB
Case No.
22-50073
ECF #
1787
Type
UNKNOWN

FULL TEXT

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

SCHEDULE "A'— POLICY FORM

(complete this section or attach full copy of policy / policies)

P o l i c y F o r m N o　D a t e d
I t e m
\$　_
,
,
0　o n　_ A D D I T I O N S & A L T E R A T I O N S I t e m
\$　o n I t e m
\$　o n I t e m
\$　o n S i t u a t e d　7
F i f t h A v e n u e　, N e w Y o r k　, N Y ,
C o i n s u r a n c e　A v e r a g e , D i s t r i b　u t i o n , o r D　e d u c t i b l e C l a u s e s , i f a n y L o s s , i f a n y ,　p a y a b l e t o
G e n　e v e r H o l d　i n g s L L C c / o L u c A D e s p i n s C h a p t e r
T r u s t e e o f H o W a n K w o k , A f f i l i a t e d A d j u s t m e n t

Group, Ltd. SCHEDULE "B" STATEMENT OF ACTUAL CASH VALUE AND LOSS AND DAMAGE

I t e m i z a t i o n i s r e q u i r e d o f p r o p e r t y i n v o l v e d , a n d f o r w h i c h c l a i m i s m a d e s h o w i n g h o w l o s s a n d d a m a g e i s a r r i v e d a t A t t a c h s c h e d u l e i f n e c e s s a r y　A C T U A L
C A S H V A L U E　L O S S A N D D A M A G E
A l l C i t y — M i t i g a t i o n　3
,
C o l l e c t i b l e a t T h i s T i m e　3
,
T h i s p r o o f o f l o s s i s w r i t t e n w i t h o u t p r e j u d i c e t o , w a i v e r o f a n d r e s e r v i n g a l l r i g h t s , t e r m s a n d c o n d i t i o n s i n h e r e n t i n a n d / o r a c c r u i n g f r o m t h e a p p l i c a b l e p o l i c i e s o f i n s u r a n c e
T o t a l s
SCHEDULE "C" - APPORTIONMENT
P O L I C Y N O　E X P I R E S　N A M E O F C O　M P A N Y　I T E M N O　I T E M N O
I N S U R E S　P A Y S　I N S U R E S　P A Y S
o t a l s
Adjuster RECEIPT FOR PAYMENT
R e c e i v e d o f　( i n s u r e r ) o f
D o l l a r s ( \$ ) i n f u l l s a t i s f a c t i o n a n d i n d e m n p o l i c y i s h e r e b y　i t y f o r a l l c l a i m s a n d d e m a n　d s u p o n s a i d c o m p a n y o n a c c o u n t o f s a i d l o s s a n d d a m a g e a n d t h e s a i d ( S t a t e w h e t h e r R e d u c e d , R e d u c e d a n d R e i n s t a t e d o r c a n c e l l e d b y p a y m e　n t ) D a t e d　1 9　The I nsu red D a t e d　1 9　The M ort gag e © A A G L t d P r o o f o f L o s s d o t　( p g
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