Hospitalisation Expenses Claim Letter

September 10, 2009

The Manager,

Claims Department,

New India assurance Ltd,

New Delhi – 110068.

Sub : Hospitalisation Expenses

Policy ID: 115A234

Dear Sir:

I was under treatment in Apollo hospital, Bangalore from 5^th to 8^th of August due to multiple bone fractures in my left leg. Since I had a problem in getting X-Ray and other related medical documents from the hospital, I was unable to submit the claim in time, which is 15 days from the date of discharge. So may I kindly request you to consider my case favourably and reimburse me the hospitalisation expenses. The related bills and documents are attached.

Thanking you,

Sincerely,

-Sd-

M. Ajay,

5, Gandhi nagar,

Bangalore – 560065,

Ph: 95835 22222

Enclosures:

1) Hospitalisation documents and Medical bills.

2) X-Ray Report.