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Legal Notice to an Insurance Company

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Sender and Recipient
The policy and the claim
What you ask the insurer to do
Serving this notice

Step 1 of 4

Sender and Recipient

Sender's full nameNeeded

For example: Ramesh Kumar

Sender's addressNeeded

House / flat / plot no.

Street, sector or locality

City area and PIN code

Insurance company's (Recipient's) nameNeeded

For example: The Grievance Officer, Example General Insurance Company Ltd.

Insurance company's addressNeeded

House / flat / plot no.

Street, sector or locality

City area and PIN code

More details — you may leave these

Sender's phone numberYou may leave this

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

Sender's emailYou 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: ramesh.kumar@example.com

A second address for the RecipientYou may leave this

House / flat / plot no.

Street, sector or locality

City area and PIN code

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LEGAL NOTICE TO AN INSURANCE COMPANY

A policyholder, nominee or claimant calling on an insurer to pay, settle or put right a claim or policy decision.

TO:
__________
__________

FROM:
__________
__________

Dear Sir / Madam,

1. THE POLICY

2. WHAT HAPPENED

2.6 The Sender has complied with the terms of the Policy and has given the Recipient the documents and information it asked for. The Sender disputes the Recipient's position and says that it is not supported by the terms of the Policy or by the law.

3. THE DEMAND

3.3 The Recipient is also asked to send the Sender, within the same time, a written reply that gives the reasons for its decision and a copy of the Policy document, the proposal form and any survey or investigation report it relies on.

4. IF THE RECIPIENT DOES NOT COMPLY

4.1 If the Recipient does not comply, the Sender will pursue such remedies as the Sender is advised, which may include a complaint to the Insurance Ombudsman, a complaint to the Insurance Regulatory and Development Authority of India, a complaint before the Consumer Disputes Redressal Commission, or a civil suit, with interest, compensation and costs.

4.2 Nothing in this notice waives any right or remedy of the Sender.

5. SERVICE OF THIS NOTICE

6. JURISDICTION AND REPLY

Yours faithfully,

ACKNOWLEDGEMENT OF RECEIPT (for use where this notice is delivered by hand)

Name: _________________ Designation: _________________

Signature: _________________ Date: ____________

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