[DATE]
[Name on Policy]
[Address of Policy Holder]
[City, State, Zip]
[XYZ Insurance Company]
[Address of Company]
[City, State, Zip]
ATT: Cancellations
RE: Insurance Policy: [#755545]
Please consider this letter as a formal request to cancel the referenced insurance policy. Please stop all debits or charges for premium payments. The effective date of policy cancellation is [DATE].
Please send a written confirmation letter to me within [30] days after the cancellation takes effect. Please refund any and all unused portion of my premium.
I look forward to hearing from you.
Sincerely,
[Name of Policy Holder]
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