|
SAMPLE
Policy Holder Information:
Insurer's Name:__________
Insurer's Street Address: _________
Insurer's City: __________
Insurer's State: __________
Insurer's ZIP: __________
Insurer's Tel.#: __________
Insurance Company Information:
Insurance Company Name: __________
Insurance Company Street Address:__________
Insurance Company City: __________
Insurance Company State: __________
Insurance Company ZIP: __________
Insurance Policy Information: __________
The Policy under which this claim is made
is __________.
The automobile insured is __________.
Loss Information: ___________
The date of the loss is __________.
The loss came about as a result of __________.
As a result of the reason described above,
the insured suffered __________.
The date of this Claim Letter is __________.
|
