POLICY SURRENDER OR FREE-LOOK CANCELLATION REQUEST

A policyholder's request to cancel a new policy in its free-look period, or to surrender a policy for its value.

TO:
The Manager, Policy Servicing
__________
__________

FROM:
__________
__________
Phone: __________

SUBJECT: Request about policy no. __________

Sir / Madam,

1. THE POLICY

1.1 I hold __________, number __________, issued by you on __________. I have paid premiums of __________ in all.

2. MY REQUEST

2.5 I understand that you may deduct only what the policy and the rules allow, and I ask you to show each deduction in writing with the clause of the policy for it.

3. WHAT I ASK YOU TO DO

3.1 Please act on this request, register it from the day you receive it, and confirm in writing the date on which the policy ends.

3.2 Please tell me the amount payable and how it is made up, and send me no further premium notice.

4. WHAT I CONFIRM

4.1 I am the policyholder and I sign this request myself. What I have written is true to the best of my knowledge.

5. PAPERS ENCLOSED

Yours faithfully,