Printable Business Form Templates
Insurance Claim Business Form Template


XYZ Business
123 Main St.
Anytown, CA 95928
(555) 555-1212

August 14, 2010

ABC Insurance
345 Any Place.
Anytown, CA 95928

Dear _____________,

This letter is to notify your firm that a loss has been incurred that is covered by the insurance you underwrite. We are in need of a formal claim form and/or a call from an adjuster so the claim can proceed.

The policy number is: ___________________

Here is the claim information:

Date/Time:

Type of loss:

Where occurred:

Estimated loss:

Thank you very much for your prompt attention to this matter.

Sincerely,








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