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Personal Accident Claim Letter

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You and the policy
The accident and its result
The claim and where to pay

Step 1 of 3

You and the policy

Your full name (the person writing)Needed

For example: Harjinder Singh Gill

Your addressNeeded

House / flat / plot no.

Street, sector or locality

City area and PIN code

Your phone numberNeeded

A number somebody can be reached on. Ten digits is the usual Indian form, and a country code in front of it is fine if you want it there.

For example: 98765 43210

You are writing asNeeded

the insured personthe nominee of the insured personthe legal heir of the insured persona person with written authority to act for the insured person

Name of the insured personNeeded

For example: Harjinder Singh Gill

Insurance company's nameNeeded

For example: ABC General Insurance Company Limited

Address of the office you are writing toNeeded

House / flat / plot no.

Street, sector or locality

City area and PIN code

Policy numberNeeded

For example: P/141234/01/2026/003318

What kind of cover is it?Needed

a personal accident policythe personal accident cover for the owner-driver under a motor policythe personal accident cover under a group policy through an employer, bank or societythe personal accident cover attached to another policy

Sum insured for personal accident, if you know itYou may leave this

An amount in rupees. Commas and a ₹ sign are both fine — write it the way you would write it anywhere else, and the document is given the tidy form of it.

For example: 1000000

More details — you may leave these

Your email addressYou may leave this

An email address somebody actually reads. Notices under a document like this can be sent to it, so a working one matters more than a tidy one.

For example: harjinder.gill@example.com

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PERSONAL ACCIDENT CLAIM LETTER

A claim under a personal accident policy or cover for death, disability or injury caused by an accident.

TO:
The Claims Manager
__________
__________

FROM:
__________
__________
Phone: __________

SUBJECT: Personal accident claim under policy no. __________ for __________

Sir / Madam,

1. THE POLICY AND THE INSURED PERSON

1.1 I write as __________. The insured person is __________, who is covered with you under __________, policy no. __________.

2. THE ACCIDENT AND ITS RESULT

3. WHAT I ASK YOU TO DO

3.1 Please register this claim, give me the claim number in writing, send me your claim form, and tell me in one list every paper you still need, with the name and number of the officer handling the claim.

3.3 If you reduce or reject any part of the claim, please give me each deduction or reason in writing, with the clause of the policy you rely on.

4. WHERE TO PAY

5. WHAT I CONFIRM

5.1 What I have written is true to the best of my knowledge, and I have kept back no fact that you would reasonably want to know. I will give you the papers listed below and any further paper you reasonably ask for.

6. PAPERS ENCLOSED

Yours faithfully,

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