Application for Free Look Cancellation of Insurance Policy


The Manager,
__________ (Name of Insurance Company),
__________ (Insurance Company Address)

Date: __/__/____ (Date)

Subject: Request for free look cancellation of policy number ________ (policy number).


Respectfully, I am _________ (Your Name) holder of an insurance policy from your insurance company ______________ (Insurance company name) taken on _______(Date of Insurance Policy Taken) having policy number __________ (Policy Number).

I want to cancel the policy under free look cancellation period due to ___________ (reason for cancellation – personal reason/wrong commitment/ financial issue/ any other reason)

I request you to kindly complete the formalities of the cancellation of the policy and transfer the amount of this policy to my account no. ____________ (account number). The said bank account is already updated in your records.

I am enclosing _________ (insurance policy bond paper/policy surrender request/ bank account statement/cancelled cheque/bank passbook copy, photo, insurance application form) along with the application.

Your prompt action on the same will be highly appreciated.

Thank you,

Signature: _____________
Your Name: __________
Policy Number: __________
Mobile number: _________

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