Request for cancellation of my car insurance

Firstname of the policyholder

Name of the policyholder

Email of the policyholder

Contract reference

ℹ️ Informations sur la résiliation de votre contrat d'assurance Vous pouvez résilier votre contrat d'assurance :

À la date anniversaire de votre contrat si vous ne souhaitez pas le renouveler (en nous prévenant au plus tard 2 mois avant cette date) ;
À tout moment après le premier renouvellement du contrat (la résiliation prendra alors effet 1 mois après votre demande) ;
Dans le mois suivant la résolution d’un sinistre (la résiliation prendra également effet 1 mois après votre demande) ;
En cas de vente de votre voiture ;
En cas de remplacement du véhicule sous garantie ;
En cas de perte totale de votre voiture.

Remarque : Conformément au Code des assurances, vous ne disposez pas d’un droit de rétractation de 14 jours pour ce type de contrat, car il s'agit d'une assurance auto souscrite à distance.

⚠️ Action required – Legal restriction Unfortunately, you cannot complete your request via this form.

According to Belgian legislation, certain types of cancellations must be completed through a legally recognized method such as a registered letter or a qualified electronic signature. This ensures the legal validity and traceability of your request.

However, good news — you can still complete this process easily and securely by signing via itsme through the form below:

👉 Go to the secure form with itsme

Thank you for your understanding.

I wish to terminate my insurance contract (subject to acceptance)

Date of cancellation

Date

Specify the reason why you wish to cancel your contract ?

Other

Can you provide us with the buyer's details so that we can contact him/her about continuing the contract or not.

Firstname, lastname and email

Proof of resale

Unfortunately, the Hamon law does not allow you to cancel for this reason during the first year of your insurance contract.

Please ask your new insurer to cancel your policy for you. Once we have received the request, we will confirm the date of cancellation

You don't have to do anything, your contract will be automatically cancelled 90 days after the purchase date of your contract

Do you have any suggestions/comments on how to improve our car insurance?

Summary of your cancellation request

The policyholder: {firstnameOf} {typeA4}

The contract: {contract}

Your request: {iWish} {dateOf}

The reason: {specifyThe}

partner