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Letter for Notification Of Claim Auto Accident


This letter notifies your insurance company of an auto claim.


1234, Main Street
Boston, MA 02123

05 April, 2005

<Recipient Address Goes Here>

Hello,

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.

Regards,

Jim Karter


encl: <List of enclosed items goes here>







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