To Health Benefits Insurer Requesting Reimbursement for Expenses
[DATE, ex. Wednesday, June 11, 1998]
[NAME, COMPANY AND ADDRESS, ex.
1234 First Street
Anycity, Anystate 85245]
Dear [NAME, ex. John Smith],
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”.
[YOUR NAME, ex. Jill Jones]