Application for Delayed Payment of Medical Insurance Policy

To,

xxxxxxxxxxxx

xxxxxxxxxxxxxxx

xxxxxxxxxxx

xxxxxxxx

                                                                                                    Date xx/xx/xxxx

Subject:- Delayed payment of Medical Insurance Policy xxxxxxxxxxxxxxxxx

Respect Sir,

My name is xxxxxxxxx and work at xxxxxxxxxxxx. I do hold an insurance policy in xxxxxxxxxxx having policy no xxxxxxxxxxxxx.

I am writing this letter to you that I failed to renew my medical insurance policy on xx/xx/xxxx due to sickness of my father. I request you to kindly accept my renewal payment of Medical Insurance Policy on xx/xx/xxxx.

Further during the period from the date of expiry of the said policy i.e xx/xx/xxxx till today, i.e., xx/xx/xxxx I myself and my family members covered under this policy have not fallen sick and all of us are well now.

Thanking You,

xxxxxxxxx

Add:- xxxxxxxxxxxx