{Date}

{Name of Insurance Claimant}

{Email Id}

{Phone Number}

To

Branch Manager

{Insurance Company’s Name}

{Branch Name and Address}

Subject: Issue Related to Insurance Policy Claim

Dear _______,

I am writing to you regarding my life insurance policy with your company. The details of my policy are as follows-

1. Policy Number
2. Name of Assured
3. Name of Claimant
4. Time, Place, Date and Cause of Death

I am dissatisfied with the claim settlement offered by the company because: (write down was was wrongful and the issue with the settlement)

Kindly find attached to this letter a copy of the insurance policy, claim intimation form, ID proof and all other supporting documents as submitted to the insurance company.

I kindly request you to look into the matter and offer a suitable resolution at the earliest.

Sincerely,

{Your name}

{Your signature or thumb print}

General Manager

Consumer Affairs Department- Grievance Redressal Cell

Insurance Regulatory and Development Authority of India(IRDAI)

Sy.No.115/1, Financial District, Nanakramguda,

Gachibowli, Hyderabad-500032

{Date}

{Name of Insurance Claimant}

{Email Id}

{Phone Number}

To

The General Manager

Consumer Affairs Department- Grievance Redressal Cell

Insurance Regulatory and Development Authority of India(IRDAI)

Sy.No.115/1, Financial District, Nanakramguda,

Gachibowli, Hyderabad-500032

Subject: Issue Related to (Name of Policy) Insurance Policy Claim

Dear Grievance Specialist,

I am writing to you to file a grievance with (Name of the Insurance Company). I have issued a claim intimation for my insurance policy. However, I believed the sum assured provided by the insurance company has not been issued in a satisfactory manner. I am submitting this letter as an Emergency Grievance because I do not agree with the decision in my case.

Please find below the details of my insurance policy-

1. Policy Number
2. Name of Insured
3. Date of Incident
4. Cause of Incident
5. Place of Incident
6. Name and Identity Proof of the Claimant
7. Explanation of claim related issue in detail

Please find attached to this letter identity proof  and a copy of the policy document, FIR Report, Claim intimation form as submitted to the insurance company.

I kindly request you to look into the matter and provide a resolution.

Sincerely,

{Your name}

{Your signature or thumb print}