From,
__________ (Name),
__________ (Address)

Date: __/__/____ (Date)

To,
The Customer Relations Officer,
__________ (Insurance Company Name),
__________ (Address)

Subject: Cancellation of insurance application no. ________ (application number)

Sir/ Madam,

With utmost courtesy, I would like to inform that my name is _________ (Name) and I am a resident of ________ (locality).

This letter is in reference to the application number ________ (application number) which was submitted from my side regarding the purchase of insurance with _______ (Mention Details – policy name/ premium/ benefits/ any other). I would like to inform you that due to _________ (mention reason for cancellation) I am not willing to proceed with the above-mentioned insurance service.

Therefore, I would like to withdraw my insurance application. I request you to kindly do the needful at the earliest. I shall be highly obliged for your kind support. In case, any query arises, you may contact me at the contact details mentioned below.

Thanking You,
________ (Signature),
________ (Name),
________ (Contact Number)

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