Your Préname/Name
Address
Postal Code/City
[Name of your insurer]
Address
Postal Code/City
Done so; [your city], on [précate the date].
Object : Report of loss covered by homeowner's insurance policy [indicate your policy number]
Madam, Sir,
I own a home located [indicate your address]. My house/apartment located at [specify the address of the dwelling] has suffered [specify the nature of the loss].
As a result, I wish to invoke the insurance that I purchased on[indicate the date of purchase of the policy].
Waiting for your return, please accept, Madam, Sir, my best regards.
[Your signature]