| | TO HEALTH BENEFITS INSURER REQUESTING REIMBURSEMENT FOR EXPENSES
[Date]
[NAME, COMPANY AND ADDRESS, ex.
Tom Atkinson
COMANY Inc.
14 Edith Street,
Hackney West,
ZIP POST CODE]
Dear [NAME, ex. Tom Atkinson],
I enclose a completed medical claim form together with receipts totaling $[AMOUNT OF RECEIPTS, ex. $233.29] in respect of [DESCRIBE NATURE OF AMOUNTS PAID, ex. minor surgery administered to our employee, [NAME OF EMPLOYEE].
Kindly provide us with a Check payable to the employee in the above amount.
Please address all correspondence to our address noted on our letterhead and marked “Personal and Confidential”.
Sincerely,
[YOUR NAME, ex. Tony Montana]
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