Free cancellation letter 19
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Request for cancellation of insurance policy

Your full name
Street address


ZIP code

Phone number

I have obtained a policy with another company and am sending you this written notice to request
cancellation of my current insurance policy. My information is listed below.
Policy type:

Home / renters

Policy number
Cancellation date (MM/DD/YY)

Time (HH:MM)

My new insurance company’s name
My new policy number
Date this policy is effective (MM/DD/YY)

Time (HH:MM)

Please confirm this cancellation and send the unused portion of my premium to the address
Your signature

Your printed or typed name
Date of signature (MM/DD/YY)