This letter notifies your insurance company of an auto claim.
1234, Main Street
Boston, MA 02123
05 April, 2005
<Recipient Address Goes Here>
Re: Policy No. <policy number>
Please be advised that I would like to make a claim on the above-referenced policy of insurance. On <date>, I was in an automobile accident with <name(s)> at <location of accident>. <name(s)> <is/are> insured as follows:
<name of driver>
<name of their insurer>
<their policy number>
A police report <was/was not> obtained at the time of the accident. The report is number <report number> and can be obtained through <name of agency that took the report> <report of any injuries>.
I would, therefore, request that <company name> adjust any claims arising out of this accident. Please contact me if you need any additional information. I look forward to hearing from you.
encl: <List of enclosed items goes here>