INSURANCE CLAIM NOTICE

INSURANCE CLAIM NOTICE

Date :

To _______________

   _______________

   _______________

Dear _______________

You are hereby notified that I have incurred a loss which I believe is covered by my insurance policy detailed below. Details of the loss are as follows:

1.  Type of loss or claim: _______________

2.  Date and time incurred: _______________ _______________

3.  Location: _______________

4.  Estimated loss:  _______________

Please forward a claim form to me as soon a possible.

Yours sincerely

Home Phone _______________

Work Phone _______________

Policy Number _______________

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