Your Préname/Name
Address
Postal Code/City
[Name of your insurance company]
Address
Postal Code/City
Done à [your city], on [précate date].
Object : Request to terminate my n° [state your policy number]
Madam, Sir,
I’have subscribed to an insurance contract with your company, no. [indicate the number of your contract] on [indicate the subscription date]. I would like to cancel this contract today on its anniversary date, which is [indicate the annual contract expiration date].
In accordance with Article L. 113-12 of the Insurance Code, I am sending you my request for termination at least two months before the annual anniversary date.
I would be grateful if you could send me a certificate of termination.
Waiting for this, please accept, Madam, Sir, my best regards.
[Your signature]