To Health Benefits Insurer Requesting Reimbursement for Expenses [DATE, ex. Wednesday, June 11, 1998] [NAME, COMPANY AND ADDRESS, ex. John Smith XYZ Inc. 1234 First Street Suite 567 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 […]
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