NAMED INSURED
ADDRESS
CITY, STATE ZIP CODE
DATE
TO:
NAME OF THE INSURANCE COMPANY
ADDRESS
PHONE NUMBER
ATTENTION: LOSS RUN DEPARTMENT
FAX NUMBER OR EMAIL ADDRESS
RE: LOSS RUN REQUEST
Policy type:___________________
Policy number_________________
Policy Period__________________
To Whom it may concern:
With regard to the above captioned policy, this letter authorizes and requests your company to release the complete detailed loss runs showing all experience ( open and closed ) for the periods to:
Name of the agency , Attention to : Agent, Email address and fax number