CANCELLATION REQUEST - POLICY RELEASE FORM
Dear (Customer Name),
RE:
Because the above mentioned policy is a three-year policy and you have advised us that you do not wish to renew this policy for another year, we must ask that you complete and sign the enclosed Cancellation Request/Policy Release form. When we receive this form we will forward it to ( ), which will then terminate the unexpired term of the policy.
As of the date of cancellation shown on this form, you will have NO COVERAGE in force for your insurable exposures under the above policy. Since you have placed this coverage elsewhere, it is important that you fill in the replacement policy number, name of the company, and its effective date on the lines indicated with an 'X'.
Thank you for completing this form, signing it, and returning it immediately. We regret that you have decided not to continue this policy with us, but we want you to know that we look forward to having you contact us should you decide that you would like us to provide your insurance needs any time in the future.
Sincerely,
Enclosure