Questionnaire - FasterDraft

Insurance Cancellation Letter

Cancellation Details
- Who is Sender?
- About this Letter
- Cancellation Details
Complete the Document
- Format & Signatures

Who is Sender?

Indicate the full name of the Sender:
Indicate the Sender's mailing address:
Indicate the Sender's policy insurance number or ID:
Indicate the Sender's contact email address:
Indicate the Sender's contact phone number:

About this Letter

Select the date on which the Sender signs and sends this letter:
Indicate the full name of the Insurer Company (or its branch that opened the Sender's insurance policy):
Indicate the Insurer's business address:
Does the Sender know the full name of the individual to whom this letter should be addressed (e.g., director)?
- No
- Yes
Indicate the full name of a person to whom this letter shall be addressed:

Cancellation Details

Select the date on which the insurance started:
State the reasons for the termination of the insurance:
Does the Sender pay for the insurance via automatic withdrawal from their bank account?
- No
- Yes
Indicate the number of the Sender's bank account:

!
Providing this information allows the insurer company to stop automatic withdrawals from the user’s bank account after canceling the insurance police.
Indicate the Sender's bank name:
The withdrawals from the bank account takes place:
Does the Sender wish to request a refund for the remaining balance of the paid insurance?
- No
- Yes
Indicate the amount of the requested refund (in USD):
Specify the method by which the Sender would like the refund to be returned:
Select the date by which the insurance shall end:

Do you want to add a signature?
- Yes
- No
Sender's signature:

Select a template's format:

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Who is Sender?

Indicate the full name of the Sender:

Indicate the Sender's mailing address:

Indicate the Sender's policy insurance number or ID:

Indicate the Sender's contact email address:

Indicate the Sender's contact phone number:

About this Letter

Select the date on which the Sender signs and sends this letter:

Indicate the full name of the Insurer Company (or its branch that opened the Sender's insurance policy):

Indicate the Insurer's business address:

Does the Sender know the full name of the individual to whom this letter should be addressed (e.g., director)?

Indicate the full name of a person to whom this letter shall be addressed:

Cancellation Details

Select the date on which the insurance started:

State the reasons for the termination of the insurance:

Does the Sender pay for the insurance via automatic withdrawal from their bank account?

Indicate the number of the Sender's bank account:

Indicate the Sender's bank name:

The withdrawals from the bank account takes place:

Does the Sender wish to request a refund for the remaining balance of the paid insurance?

Indicate the amount of the requested refund (in USD):

Specify the method by which the Sender would like the refund to be returned:

Select the date by which the insurance shall end:

Do you want to add a signature?

Sender's signature:

Select a template's format: