Cancellation of an auto insurance or home insurance policy Reminder: if the insurance contract is terminated by the insured, the insurer must refund the excess of the premium actually paid over the premium earned from the time the contact has been in force, calculated on the basis of the Cancellation Table. The Cancellation Table is part of the insurance contract. First name Last name Email Telephone Policy number? Requested termination date Is there more than one insured member designated under the contract? Yes No Insured Applicant's statement I want the insurance contract mentioned above to be terminated on the date indicated. I understand that the termination will take effect on the date specified in this form, following the reception of this email by SSQ Insurance. Multiple insured First and last names of the other insured members I am authorized to terminate the insurance contract on behalf of the other designated insured members. Applicant's statement We want the insurance contract mentioned above to be terminated on the date indicated. We understand that the termination will take effect on the date specified in this form, following the reception of this email by SSQ Insurance. Termination reason (optional) - None -Premium increase / Lower premium with another insurerThe coverage does not fulfill my needsInsatisfaction with SSQ Insurance’s customer serviceInsatisfaction with SSQ Insurance’s service during a claimI no longer own the covered propertyOther reason... Specify Message (optional) Attach files Attach files Documents accepted: gif, jpg, png, bmp, pdf and doc. Size maximum 5MB per file and size for all files should not exceed 15 MB. File 1 File 2 File 3 Leave this field blank