To,
The Manager,
__________ (Name of Insurance Company),
__________ (Insurance Company Address)
Date: __/__/____ (Date)
Subject: Loss of Insurance policy bond, policy number ________ (policy number).
Sir/Madam,
I, _______________ (Policy Holder Name), son of/ daughter of/ wife of _______________ residing at ( Address) had taken an insurance policy from your insurance company on _______(Date of Insurance Policy Taken) bearing policy number __________ (Policy Number).
I hereby confirm that I had received the original Policy issued the Company, however, inadvertently I ________ (lost/misplaced) the policy. I have already searched for the policy but unable to find the same.
Therefore, I request you to issue to me a copy of the policy.
I undertake that if I found an original bond I will immediately return the same to Insurance company without any delay. Also will not misuse and hold the company responsible in any matter regarding the loss of original policy. I am enclosing _________ (undertaking/affidavit/photo/application form) along with the application.
Look forward to your kind support.
Thank you,
Signature: _____________
Your Name: __________
Policy Number: __________
Mobile number: _________
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