__________ (Name of the Insurance Company)
__________ (Address)

Date: __/__/____ (Date)

Subject: Claim Money Refund for Policy _________ (Policy No.)

Respected Sir/ Madam,

With due respect, I would like to inform you that, recently on __________ (Date), I purchased a policy from your company __________ (Policy name) bearing policy ID __________ (ID number). I would like to bring to your kind notice that I am not willing to carry this policy in my name any further and request you kindly refund the policy amount. I am currently eligible to avail __________ (Full/ Half) percent of the deposited amount. The following are the details of the policy:

Name- __________ (Mention Name)
Policy ID number- __________ (Policy ID number)
Date of issuance- __________ (Mention Date)

I expect your quick and kind response in this regard. You may contact me at the contact details mentioned below.

Thanking you,
__________ (Signature)
__________ (Name)
__________ (Contact Details)