The Insurance Cancellation Form is a critical document used in the Belgian insurance market for terminating insurance policies in compliance with local regulations. This document is essential when a policyholder wishes to cancel their insurance coverage, whether due to policy changes, finding better rates elsewhere, or other circumstances. The form must comply with the Belgian Insurance Act of 2014 and related regulations, including specific notice period requirements and consumer protection provisions. It captures crucial information such as policyholder details, policy information, desired cancellation date, and reason for cancellation. For mandatory insurance types, such as automobile insurance, the form includes additional sections for declaring new coverage arrangements. The document is designed to protect both the policyholder's and insurer's interests while ensuring smooth processing of the cancellation request.
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1. Policyholder Information: Essential details of the policyholder including full name, address, contact information, and national registration number
2. Insurance Policy Details: Specific information about the insurance policy being cancelled, including policy number, type of insurance, and insurer details
3. Cancellation Declaration: Clear statement of intent to cancel the insurance policy
4. Effective Date: Specified date when the cancellation should take effect
5. Reason for Cancellation: Field to indicate the reason for cancellation (may be required for certain types of insurance)
6. Signature Block: Space for date, signature, and name of the policyholder
1. Premium Refund Request: Section to request refund of prepaid premiums, used when applicable
2. New Insurance Declaration: Declaration of new insurance coverage, required for mandatory insurance types like car insurance
3. Special Circumstances: Section for explaining any special circumstances affecting the cancellation (e.g., death of insured, sale of insured property)
4. Power of Attorney: Section to be included when the form is being submitted by someone other than the policyholder
5. Language Selection: Choice of language for correspondence, required in bilingual regions of Belgium
1. Proof of New Insurance: Attachment for proof of new insurance coverage (required for mandatory insurance types)
2. Supporting Documentation: Schedule for any required supporting documents (e.g., death certificate, property sale agreement)
3. Premium Calculation: Detailed calculation of any premium refund due
4. Policy Terms Extract: Relevant extracts from the policy terms regarding cancellation rights and procedures
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