The Insurance Cancellation Form is a crucial document used in the Hong Kong insurance market to facilitate the formal termination of insurance policies before their natural expiry date. This document is essential when policyholders wish to terminate their coverage early, whether due to policy replacement, change in circumstances, or other reasons. The form must comply with Hong Kong's Insurance Ordinance (Cap. 41) and the Insurance Authority's guidelines on policy termination. It captures vital information including policyholder identification, policy details, cancellation effective date, premium refund calculations, and necessary declarations. The document serves as official evidence of the policyholder's request to cancel and the insurer's acknowledgment, protecting both parties' interests while ensuring regulatory compliance.
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1. Policyholder Information: Details of the policyholder including full name, address, contact information, and identification numbers
2. Policy Details: Specific information about the insurance policy being cancelled, including policy number, type of coverage, and original effective date
3. Cancellation Request: Clear statement of the policyholder's request to cancel the policy
4. Effective Date of Cancellation: Specified date when the insurance coverage will terminate
5. Declaration of Understanding: Statement confirming the policyholder understands the implications of cancellation
6. Premium Refund Information: Details of any premium refund calculations and payment method
7. Signatures: Space for policyholder signature and date, with witness signature if required
1. Third-Party Interests: Required when there are lienholders or other parties with interests in the policy
2. Premium Finance Agreement: Needed when the policy premiums are financed through a third party
3. Claims History Declaration: Required when there are pending or recent claims that might affect the cancellation
4. Replacement Coverage: Optional section for confirming whether the policy is being replaced with another insurance policy
5. Reason for Cancellation: Optional field for tracking purposes and quality improvement
1. Schedule A - Premium Refund Calculation: Detailed breakdown of premium refund calculation including short-rate or pro-rata terms
2. Schedule B - Policy Coverage Summary: Summary of coverage being cancelled for multi-component policies
3. Appendix 1 - Required Documents: List of supporting documents required for cancellation
4. Appendix 2 - Rights and Obligations: Summary of policyholder's rights and obligations post-cancellation
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