<<Agncy_Name>>
<<Agncy_Address>>
<<Agncy_City>>, <<Agncy_State>>  <<Agncy_Zip>>
 
Phone: <<Agncy_Phone>>  |  Fax: <<Agncy_Fax>> 

<<Today>>

<<Cli_NamedInsureds:PC>>
<<Cli_Address:PC>>
<<Cli_City:PC>>,<<Cli_State:UC>> <<Cli_Zip>>

RE:  	Company:  <<Pol_Company>> 
	Policy Number:  <<Pol_PolNum>>

Dear <<Cli_FirstNames:PC>>,
 
Effective <<Input:Date of Change?>>, we have made the following changes:
1)	<<Input:what is change?>>
As in the past, you will receive an amendment from the company.  Review it carefully. If there are any further changes or additions, please advise us at once.
To verify this request, sign where indicated and return it to our office for our record keeping.  If this information is incorrect, please call us immediately to make the corrections.
Please note that we have a website.  Please visit us at <<Input:Web address>>.

Sincerely,

<<User Name>>
<<User_Notes>>
<<User_Email>>

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