Notice to Deceased’s Vehicle Insurance Company

Date: 	

	
	
[insert insurance company name and address]

Name of deceased: 	
Address: 	
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 this insurance policy. Enclosed with this letter you will find a certified death certificate for 	 [deceased’s name], documentation of my status as executor, 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 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: 	
Relationship to deceased: 	
Address: 	
Home phone: 	
Work phone: 	
Email: 	
Receipt acknowledged by:
Signature: 	
Printed or typed name: 	
Title: 	
Date of receipt of notice: