~MONTH~ ~DD~, ~YYYY~

~CLTADR~

RE:  Policy Change Request 
Policy Number:  ~POLNUM~
Insurance Company:  ~POLWCMP~
Policy Period:  ~POLTEFF~ to ~POLTEXP~

Dear ~FCTACT~, 

Enclosed you will find a Policy Change Request form authorizing the recent change(s) you requested to your policy with ~POLWCMP~ effective ~EFFDATE~.  Please review the information and let us know if there are any changes or corrections that need to be made.

Please sign and/or initial the form in the designated area(s), and return it to our office at your earliest convenience.  Once the completed form is received, the requested change(s) will be processed.

Feel free to contact us with any questions or concerns.  We greatly value your business and look forward to hearing from you soon.

Regards,

~OPNAME~