The Hospital Manager,
___________ (Name of the Hospital),
___________ (Address)

Date: __/__/____ (Date)

___________ (Name of the patient),
___________ (Address)

Subject: Request for issuance of ________ (document details)

Respected Sir/Madam,

I wish to inform you that, I am __________ (Name) and I come from ___________ (Address). I have undergone a treatment for ____________ (Name of the treatment) on _________ (Date) in your hospital.

I am writing this letter to inform you that at the time of admission my ________ (medical insurance card/any other document) was submitted at your office for ________ (purpose) purposes bearing _________ (Policy/ID number). This was in the name of _________ (Name). I am writing this letter to request you to kindly return the card. As I have been discharged from the hospital.

I look forward to your kind response. I shall be highly obliged.

Thanking You,

Yours Sincerely,
_____________ (Name),
_____________ (Signature)

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