This Letter requests claim forms from the Insurance Company, typically for use with in a Company health or Insurance plan.

Date

<Recipient Address>

Hello

Re: Member No. <Member number>
Group No. <group number>

This is to state that I require <number of forms> claim forms for use in reporting claims on the above-referenced health insurance policy. I shall appreciate it highly if you would kindly send me the same.

Thank you for your prompt assistance.

Regards,

Name

encl: <List of enclosed items goes here>