Dear …

RE: Application for __(type of insurance )__ Insurance Reference: __(# / Name)__

I have recently been made aware that __(name of insurance company)__ has declined my __(medical/auto/homeowners/etc)__ insurance application. As of today, I have not received any indication as to why my application has been rejected. Please provide me with an explanation of your reasons for arriving at this decision.

I personally believe that I am a good risk for __(type of insurance)__ insurance and, consequently, I wish to appeal the decision your company has made. Please advise me of the steps that I may take to present my case for appeal. You may contact me at __(phone # and address)__.

I look forward to hearing from you soon.

Yours truly,