Supplemental Coverage Notification

[NAME]

[ADDRESS]

[PHONE]

[DATE]

[NO FAULT ADJUSTER]

[YOUR INSURANCE COMPANY ADDRESS]

Re:        [YOUR NAME] 

              D/A:   [DATE OF ACCIDENT]

              Policy Number:  [YOUR POLICY NUMBER]

              Claim Number: [YOUR CLAIM NUMBER]

              Your insured:  [NAME OF POLICY HOLDER] 

 

Dear  Sir/Madam: 

Please be advised that [NAME OF INJURED PERSON] sustained serious personal injuries in the above-mentioned collision.   

Enclosed herewith please find a completed no-fault application. Furthermore, this letter is to serve as notice of the intention to pursue an uninsured/underinsured motorists claim.

I would like to thank you for your anticipated cooperation in the future.  Your attention to this matter is greatly appreciated.

 

Respectfully, 

 

[YOUR NAME]

Enclosure(s) [SEND WITH NO FAULT APPLICATION]

 

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