Client cancellation request form, for TP to complete Client cancellation request form, for TP to complete Today's Date MM slash DD slash YYYY Insured's Email(Required) Email address of second named insured Name of Insured(Required)Name of agent filling this outEmail address of agent filling out this formName of TP who will compete this requestFloreMayaRanDid we do an insurance review?YesNoDate when we did the insurance reviewAgent who did the insurance reviewWhy exactly are they cancelling? (be specific)(Required)Number of policies to cancel12345Do we need to update the mailing address before we cancel the policies?NoYesWe need to update the mailing address. What does the mailing address need to be?Does TP need to get the signed cancellation forms for the policies? Explain the situation.Policy #1Policy typeSituationThis policy is leaving the agency, try for WINBACK!This policy is leaving the agency, don't try for winback.We moved policy to different companyCompanyPolicy numberEffective Date of Cancellation MM slash DD slash YYYY Policy #2Policy typeSituationThis policy is leaving the agency, try for WINBACK!This policy is leaving the agency, don't try for winback.We moved policy to different companyPolicy numberEffective date of cancellation MM slash DD slash YYYY CompanyPolicy #3Policy typeSituationThis policy is leaving the agency, try for WINBACK!This policy is leaving the agency, don't try for winback.We moved policy to different companyPolicy numberEffective date of cancellation MM slash DD slash YYYY CompanyPolicy #4Policy typeSituationWe're moving them to another company.This policy is leaving the agency, try for WINBACK!This policy is leaving the agency, don't try for winback.Policy numberEffective date of cancellationCompanyPolicy #5Policy typeSituationThis policy is leaving the agency, try for WINBACK!This policy is leaving the agency, don't try for winback.We moved policy to different companyPolicy numberEffective date of cancellation MM slash DD slash YYYY CompanyUntitled
