I am writing regarding the payment notice sent to me

November 3, 2011

Joseph Hall
1902, X Street, Madison Avenue,
Los Angeles, CA-90001
(123) 456-7890

[Subject: Normally bold, summarizes the intention of the letter] -Optional-

Dear  Joseph Hall,

I am writing regarding the payment notice sent to me, Jean Hayes, with insurance number 12345. I was informed that I have not made the necessary premium payments for the past two quarters and am now being charged for three quarters. This does not make sense to me because I have never missed a payment schedule. Furthermore, I would have forfeited my policy if I had missed two payment schedules in a row. In any case, I am attaching copies of my receipts. Please correct the error as soon as possible and send me an updated statement. Thank you.

Sincerely,
Alger

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