<<Agncy_Name>>
<<Agncy_Address>>
<<Agncy_City>>, <<Agncy_State>>  <<Agncy_Zip>>
 
Phone: <<Agncy_Phone>>  |  Fax: <<Agncy_Fax>> 

<<Today>>

<<Input:Other agency / carrier name>>
<<Input:Other agency / carrier address>>
<<Input:Other agency / carrier city, state zip>>

RE: <<Cli_NamedInsureds>>

Please cancel the <<Input:policy / policies>> listed below effective <<Input:cancellation date>> and make any necessary refund to <<Cli_NamedInsureds>>.  Coverage has been secured elsewhere <<Input:cancellation date>> .

<<Input:Policy Number 1>>	<<Input:Policy Number 1 Type>>
<<Input:Policy Number 2>>	<<Input:Policy Number 2 Type>>
<<Input:Policy Number 3>>	<<Input:Policy Number 3 Type>>
<<Input:Policy Number 4>>	<<Input:Policy Number 4 Type>>

Thank you for your past services

Sincerely,

<<Cli_NamedInsureds>>