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Policy number: ________
Claim reference: ________

Dear Sir or Madam,

RE: Submission of further evidence in support of a rejected insurance claim under policy number ________

I write further to your decision to reject my claim made under the above policy of insurance (the "Policy"), a contract of insurance between myself, ________ (the "Policyholder"), and ________ (the "Insurer").

1. The Claim

1.1 My claim relates to loss of or damage to the following items (together, the "Items"):

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1.2 The loss or damage was incurred on ________ in the following manner:

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1.3 The total value of the loss claimed is ________.

2. The Rejection

2.1 By letter dated ________, the Insurer rejected my claim on the following stated grounds:

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2.2 A copy of the Insurer's rejection letter is enclosed with this letter for ease of reference.

3. Grounds for Reconsideration

3.1 I respectfully but firmly dispute the Insurer's decision to reject my claim for the following reasons:

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4. Further Evidence

4.1 Since receiving your rejection, I have obtained the following further evidence, which is enclosed and which I consider supports my claim:

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4.2 The documents enclosed with this letter are listed as follows: ________.

5. Requested Action

5.1 In light of the matters set out above, the loss is in my view duly covered by the Policy. I therefore request that you reconsider your decision and settle my claim in full, together with any interest properly due, without further delay.

5.2 I look forward to receiving your substantive response within 14 days of the date of this letter. Please treat this letter, together with any subsequent correspondence, as an expression of dissatisfaction and, if my claim is not resolved to my satisfaction, as a complaint under your internal complaints procedure in accordance with the FCA's Dispute Resolution: Complaints Sourcebook (DISP).

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Yours faithfully,



________
Enc.