I am assuming you want to be reimbursed for things that have been lost or stolen from you. How about . . . .
To Whom It May Concern,
On (date), the following articles were (lost , stolen) from (location or place where itmes went missing.) I undertand that I am eligible for reimbursement from (your company or agency) for the value of these articles.
The items are valued at (state value in money terms OR list separate and total)
Please remit to (your name and address).
I thank you for your time.
(signature and date)