This letter requests claim forms from your insurance company, typically for use within a company health or insurance plan.
1234, Main Street
Boston, MA 02123
05 April, 2005
<Recipient Address Goes Here>
Hello,
Re: Member No. <member number>
Group No. <group number>
I would appreciate it if you could please send me <number of forms> claim forms for use in reporting claims on the above-referenced health insurance policy.
Thank you for your assistance.
Regards,
Jim Karter
encl: <List of enclosed items goes here>
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