When a client wants to cancel, you need their policy number, the date coverage should end, and their signature. This insurance cancellation form template collects all three online, so you’re not chasing a signed letter by email.
It works for independent agencies, brokers, and insurers handling auto, home, renters, life, or business policies, whether clients call it a policy cancellation request or a cancellation letter.
What Goes on an Insurance Cancellation Form?
The form is split into short sections, and the new-insurer questions only appear when a client says they’re switching.
On this insurance cancellation form, we’ve included the following fields:
- Policyholder name
- Policy number and policy type
- Cancellation effective date
- Reason for cancelling
- New insurance company and start date
- Email, phone, and mailing address
- Authorization statement
- Signature and date signed
You’ll get an email for each request and the client gets a copy. Edit the authorization text to add your notice period, fees, and refund terms.
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