Sample Auto Insurance Cancellation Form

[Date]

[Insurance Company Name]

Attention: [Name, if any. or Customer Service]


I am writing to inform you that as of [Date of cancellation], I am canceling the auto insurance policy I currently have with you. My auto insurance policy number__[Current Policy Number]_____ has been replaced with [New Company Name] policy effective [New Policy Effective date].

(Policy # : [Current Policy Number])

Please promptly refund the unused portion of my premium directly to me at:

[Your Name]
Street Address:_____________________________
City, State, Zip Code: _________________________




Signed:____________________________________________