Authorization to Release Medical Details/Records for the Purpose of Insurance & Policies Underwriting for [Policy Number/s] (Sample Letter)

[ Policyholder’s full name & contacts ]

Attention: Health Records Management Department


Cc: The Underwriting & Investigation (U & I) Department
American International Assurance Company Limited

Date of this letter:

To Whom It May Concern

Subject: Authorization to Release Medical Details/Records for the Purpose of Insurance & Policies Underwriting for [Policy Number/s]

Kindly be informed that I [policyholder’s name & IC No.] hereby authorized your medical centre to release to one [agent’s name, contacts & agent code] all my medical and health records & information requested by him on behalf of his insurance company to facilitate his rendering of his insurance underwriting process.

My sincere hope that this shall be of good and sufficient authority for your next course of action.

Your co-operation & co-ordination to one [agent’s name, contacts & agent code] on this matter is highly appreciated and please do feel free to contact me at the undersigned should your medical centre requires authentications and verification on this matter.


Yours sincerely,



………………………………….
[ Policyholder’s full name & contact ]