Care Concept AG | Kündigungsantrag zur Care Economy Auslandsversicherung

Care Concept AG
– Policy Department –
P. O. Box 33 01 51

53203 Bonn

Fax.: 0800 977 35 35 | e-Mail: info@care-concept.de

Termination of the Policy	Policy number

**Policyholder**

**Insured person**
	born on:

**Contact information**
\| \| - \|

Dear Sir or Madam,

  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.

  Originally contracted expiration date of the policy is .... .

I will transfer/transferred to the compulsory health insurance on... . Reason:

I will end/ended my stay abroad on... . An appropriate certification (e.g., travel documents) is enclosed.

I will end/ended my stay abroad on... . As the departure will take place/took place on , documentation cannot yet be provided.

Faithfully yours,
________________________________	________________________________
Date, signature of the insured person (bei minderjährigen Personen Unterschrift des gesetzlichen Vertreters)	Policyholder’s signature

Termination of the Policy