Cancellation of Insurance Policy

In accordance with Article D. 113-7 I. of the French Insurance Code, after the first anniversary of your policy, you may cancel it at any time. The cancellation request must be submitted through the form below. The cancellation will terminate your coverage on the effective date of the cancellation, without the possibility of a refund for the elapsed period. No penalty fees will be applied for this cancellation, and you will be reimbursed for any overpaid amounts.

If you wish to cancel your policy, please fill in the requested information below.

Cancellation request summary

Please verify that all the information below is correct and click on "Submit my request".

Title: {Title:22}
Full name: {First name:11} {Last name:23}
Contract type: {What kind of contract do you want to cancel?:19}
Contract number: {Contract number:17}
E-mail: {E-mail:8}
Telephone : {Telephone:9}
Desired cancellation date: {Desired cancellation date:28}{Cancellation date:29}

{What is your reason for cancellation?:13}