Month Day, Year

VIA FACSIMILE ONLY ( )
( INSURANCE COMPANY )
ATTN: ( claims dept or adjuster )
( address )

RE: YOUR INSURED: ( )
OUR CLIENT: ( )
DOA: ( )
CLAIM # ( )

Dear Sir or Madam:

This firm has been retained to represent the above referenced client in a claim resulting from an accident which occurred on the above date. You are required by law to furnish said copies.

Pursuant to Section 627.4137 of the Florida Statutes, please provide the undersigned with the following information with regard to each known policy on insurance, including excess or umbrella coverage, which may provide liability insurance coverage for this claim:

a. Name of the insurer (s)
b. Name of each insured
c. Certified copy of limits if liability coverage for the following categories:
1. Personal injury
2. Property damage
3. Medical expenses
4. Personal Injury Protection
5. Uninsured motorist and any other coverage
d. A statement of any policy or coverage defense which your company reasonably
believes is available
e. A certified Copy of any and all insurance policies

The requested information must be provided within thirty (30) days from the date of this letter and must include a statement under oath by a corporate office. Please direct any further communication with our client regarding this matter to my office.

Sincerely,

Eiman Sharmin Esq.