Notice to Deceased's Vehicle Insurance Company

Date: __________________

_______________________
_______________________
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[insert insurance company name and address]

Name of deceased: __________________
Deceased's address:	______________________
______________________
Deceased's Social Security number: __________________
Date of death: _____________

Vehicle insurance policy number: __________________
Make, model, and year of vehicle: __________________

This letter is to notify you that your insured, ________________________ [deceased’s name], has died. I am the executor of the estate and would like to be added as a named insured to the above-referenced insurance policy. Enclosed with this letter you will find a certified death certificate for ______________________ [deceased’s name] and a state-certified copy of my driving record.
Please contact me so that we may discuss this matter. I can be reached using the information listed below. Please sign and return the second copy of this letter in the enclosed stamped and self-addressed envelope.
Thank you for your assistance.

Signature: ______________________________________________
Printed or typed name: _____________________
Address:	_____________________
_____________________
Home phone: ______________	Work phone: ______________
Email: ________________

Receipt acknowledged by

Signature: __________________________________________
Printed or typed name: __________________
Date: _______________
Title: _______________