Insurance Cancellation Form Template for Malaysia

The Insurance Cancellation Form is a crucial document used in the Malaysian insurance industry when a policyholder wishes to terminate their insurance coverage before its natural expiry date. This document is designed in accordance with the Financial Services Act 2013 and relevant Bank Negara Malaysia guidelines, ensuring proper documentation of policy terminations while protecting both insurer and policyholder interests. The form collects essential information including policyholder identification, policy details, cancellation reasons, and refund calculations, while incorporating necessary declarations and acknowledgments. It serves as a legal record of the cancellation request and helps insurance providers maintain compliance with regulatory requirements for policy terminations in Malaysia.

1. Policyholder Information: Essential details of the policyholder including full name, NRIC/passport number, policy number, and contact information

2. Policy Details: Specific information about the insurance policy being cancelled, including type of policy, effective date, and premium amount

3. Cancellation Request: Clear statement of intent to cancel the policy, including requested cancellation date

4. Reason for Cancellation: Section for policyholder to state reason for cancellation (required for statistical and quality improvement purposes)

5. Premium Refund Details: Information about any applicable premium refund calculations and payment method preferences

6. Declaration: Policyholder's confirmation of understanding the cancellation implications and authorization statement

7. Acknowledgment: Space for signatures, dates, and witness information if required