[Insert date]
[Policyholder’s full name]
[Policyholder’s mailing address]
[City], [State] [Zip code]
[Mr/Ms.] [Policyholder’s last name]:
This letter is to serve as confirmation that [insert policyholder’s name] carries continuous personal
automobile insurance coverage with [insert name of insurance company], NAIC Code [insert NAIC
code] for the following vehicle:
• [Insert vehicle identification number (VIN)]
• [Insert year] [Insert vehicle make] [Insert vehicle model]
The policy number is [insert policy number]. This policy has been in full effect since [list start date
for policy], with no lapse in coverage. [Note: If there was a lapse in coverage, this will need to be
adjusted accordingly to specify the timeframe].
The named insureds on this policy are:
• [Policyholder’s first and last name]
• [First and last name of additional named insured]
• [First and last name of additional named insured]
By signing this letter, I indicate that the above information is true and correct as of the date of this
letter. If you require any additional information, please contact me at [insert email address] or
[insert phone number, with extension if applicable].
Regards,
[Signature]
[Typed name of authorized insurance company representative]
