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(Date of Letter)

(Insurance Company Name) (Claims Adjuster) (Street Address) (City, State and Zip Code) RE: (Name of Insured) (Claim Number) (Date of Loss) (Policy Requested)

Dear Claims Adjuster: On behalf of (name of insured or other individual or entity), the undersigned hereby respectfully requests that a copy of the insurance policy noted above and/or declaration sheet ("dec" sheet) be provided for analysis and review. The undersigned represents (name of insured or other individual or entity) in conjunction with a potential claim under the aforementioned policy. Since there may be some question as to the contract language or the interpretation of the language contained within the policy, it is hereby requested that a certified copy of the policy and/or declaration sheet (strike one if appropriate) be provided to the undersigned within the next days. Should any addendums, riders, and/or any executed waivers of any sort apply to the policy, this request is meant to include those documents, bearing the dates and signatures when and where appropriate. These documents must also be certified in order for my file to be accurate and complete. Should you have any questions relative to this matter, please contact the undersigned as soon as possible. Very truly yours,

(Signature) (Address) (City, State and Zip Code) (Phone Number) LAWCHEK, LTD. LETTER PRO Samples, Copyright 2000 This is not a substitute for legal advice. An attorney must be consulted.