I hereby give notice of termination of the above-mentioned insurance policy
effective as of ....
or at the earliest possible date. Please send written confirmation of termination of the policy to the above-mentioned address.
An appropriate certification (e.g., travel documents) is enclosed
Documentation cannot yet be provided, because
Mit freundlichen Grüßen
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Date, signature of the insured person(bei minderjährigen Personen Unterschrift des gesetzlichen Vertreters)
