SAMPLE CHANGE OF ADDRESS LETTER

 

Date:___________________

 

                                  File #: Claim Number

 

Employee:____________________    

 

Claimant:_____________________       

Name of Claimant

Address (Line 1)

Address (Line 2)

Address (Line 3)

 

Change of Address

 

This will notify you of my change of address to the following:

 

Name

 

Address

 

City/State/Zip

 

Phone Number

 

 

Other Information:

 

 

 

 

 

 

_________________________________         _______________

Signature                                 Date