To,

The Manager,
Bajaj Allianz General Insurance Co. Ltd.
Block No;-4,7th Floor, DLF Tower, 15,
Shivaji marg, New Delhi-15

Dear Sir,

I, _______________ own the car no-________________which is

insured under policy number __________________ from your
company. During the policy period car met with an accident on dt;-
_____________ for which the claim is raised.

As vehicle was badly damaged and want to retain the vehicle.

You are requested to settle the claim on other mode of settlement

rather than repairing. Thanking you in anticipation. I will not raise
any issue regarding this in future and claim settlement will purely be
on my special request.

I will be obliged.

Thanks