Motor Accident Insurance Claim Letter - English
Copy this sample, replace placeholders with your facts, and attach proof before sending it to the company, regulator, or official portal.
{{placeholders}} with your actual details.SAMPLE TEMPLATE ONLY / केवल नमूना टेम्पलेट
Important: This is a sample template for reference only. It is NOT legal advice. We are NOT lawyers. You must customize this template with your specific details and consult a qualified lawyer before using it for any legal purpose.
महत्वपूर्ण: यह केवल संदर्भ के लिए एक नमूना टेम्पलेट है। यह कानूनी सलाह नहीं है। हम वकील नहीं हैं। किसी भी कानूनी उद्देश्य के लिए उपयोग करने से पहले इसे अपने विवरण के साथ अनुकूलित करें और योग्य वकील से परामर्श करें।
How to Use This Template
Replace placeholders
Add names, dates, IDs, amounts, and complaint references.
Attach proof
Add invoices, screenshots, statements, photos, or official responses.
Send and track
Submit through the right channel and save acknowledgement details.
Template Content
Replace placeholder values before using this sample.
To,
Claims Department / Motor Claims Manager
{{insurance_company}}
{{company_address}}
Subject: Motor Accident Insurance Claim - Policy {{policy_number}}
Dear Sir/Madam,
I, {{your_name}}, policyholder of Motor Insurance Policy No. {{policy_number}}, am filing a claim for damages sustained in a motor vehicle accident.
Policy Details:
- Policy Number: {{policy_number}}
- Policy Type: {{policy_type}} (Comprehensive/Third Party)
- Vehicle: {{vehicle_make_model}} ({{vehicle_year}})
- Registration: {{vehicle_number}}
- Engine No: {{engine_number}}
- Chassis No: {{chassis_number}}
- Policy Period: {{policy_start}} to {{policy_end}}
- IDV (Insured Declared Value): ₹{{idv}}
Accident Details:
- Date & Time: {{accident_date}} at {{accident_time}}
- Location: {{accident_location}}
- Description: {{accident_description}}
- Weather/Road Conditions: {{conditions}}
- Other Vehicle Involved: {{other_vehicle}} (if applicable)
- Injuries: {{injury_details}} (if any)
FIR / Police Report:
- FIR Number: {{fir_number}}
- Police Station: {{police_station}}
- FIR Date: {{fir_date}}
Damage Assessment:
- Estimated Repair Cost: ₹{{repair_estimate}}
- Surveyor Visit Requested: Yes
- Vehicle Current Location: {{vehicle_location}} (Garage: {{garage_name}})
Documents Attached:
1. Policy document copy
2. Driving License of driver at time of accident
3. Vehicle Registration Certificate (RC)
4. FIR copy
5. Photographs of accident scene and vehicle damage
6. Repair estimate from authorized garage
7. Medical reports (if injuries involved)
I request:
1. Appointment of surveyor at the earliest
2. Cashless repair at network garage / Reimbursement of repair costs
3. Towing charges reimbursement: ₹{{towing_charges}}
Claim intimation already done via helpline: Ref {{claim_intimation_ref}} on {{intimation_date}}.
Regards,
{{your_name}}
{{your_phone}}
{{your_email}}
Date: {{date}}Related Guide
Insurance Claim Reject Hua? IRDAI Complaint Guide (2026)
View step-by-step complaint process →
More Complaint Templates
Browse more ready-made complaint letter formats.