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Accident Claim Notice
ACCIDENT CLAIM NOTICE
[Date]
[Mr/Mrs/Ms/Dr] [First Name of receipient] [Last Name of receipient]
[Title of receipient]
[Company of receipient]
[Address of receipient]
[City of receipient], [State of recipient] [Zip Code of receipient]
Dear [Mr/Mrs/Ms/Dr] [Last Name of recipient]:
You are hereby notified of a claim against you for damages arising from the following accident or injury, which in my opinion, you and/or your agents are liable.
Description of Accident: [Description of Accident]
Date: [Date]
Time: [Time]
Location: [Location]
Please have your insurance representative or attorney contact me as soon as possible.
Very truly,
Name: [Name of person notifying]
Address: [Address of person notifying]
Telephone: [Telephone of person notifying]