Request for cancellation of my car insurance

Request for cancellation of my car insurance

Complete this form to request cancellation of your car insurance policy
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)*

In the first year of my contractAt the renewal of my contractAt a specific date (after the 1st year of my contract)
Date of cancellation*

DayMonthYear
Date
Specify the reason why you wish to cancel your contract ?*

I sold my carThe price is too highI had a bad experience with the customer service of my insurance companyI found another insurerI am not satisfied with the handling of my claimThe purchase of my vehicle has been cancelledChange in the conditions or rate of my policyOther
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
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
Should be Empty: