ACCOUNT_FIRST_NAME ACCOUNT_LAST_NAME

ACCOUNT_JOB_COMPANY

Current Date: 27 December 2024

Dear Dr DOCTOR,

The NAME, of which I am a policyholder, has asked for completion of the enclosed claim form for benefits for the period I was in your hospital and later the NURSING.

I have pencilled in the details requested on the side of the form which the company with you to complete; this may assist you.

I have attached accounts covering both hospital and nursing home accommodation for TOTAL as follows:

Hospital (START to LAST)

Nursing Home (START_N to LAST_N)

The company would like you to return the completed claim form to them. I enclose an addressed envelope for this purpose.

........................................