Self Declaration Letter for Mediclaim – Sample Declaration Letter

The Customer Service Manager,
___________ (Company Name),
___________ (Address)

Date:__/__/____ (Date)

Subject: Declaration for Mediclaim

Respected Sir/ Madam,

I __________ (Name) S/O, D/O, W/O ____________ (Name), a resident of ____________ (Residential Address) am writing this letter to you in order to declare that I do carry a mediclaim policy in your company. I am working in __________ (Company Name) having employee ID _________. I hereby declare that I have taken up (Policy details) having policy number __________ (policy number) amounting __________ (amount)

I applied for a medical and I hereby declare that all information provided in the application is true to the best of my knowledge. I ensure that I have not applied for medical claims from any other company/organization. I request you to kindly approve my request and provide me with a claim for the expenditures made.

Thanking you,
__________ (Signature)
__________ (Name),
__________ (Address),
__________ (Contact Number)

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