Your First name/Last name

Address

Postal code/ CITY

[Name of your insurer]

Address

Postal code/ City

Done in [your city], on [specify the date].

Subject: Claim declaration

Madam, Sir,

Holder of insurance contract [auto or home] No. [Contract number], I regret to inform you that on [specify the date], at [specify the time], I was the victim of the following incident:

- My vehicle [Indicate the make and model] [Specify the circumstances of the incident]. Please find attached a copy of the accident report as well as details of the damages incurred.

- I noticed water damage. [Specify the circumstances of the incident]. Please find attached a copy of the accident report as well as details of the damages incurred.

- I noticed a break-in theft [Specify the circumstances of the incident]. Please find attached the police report receipt.

I kindly ask that your expert contact me as soon as possible in order to assess the amount of damages to be compensated.

[Your signature]