Revoke application

Please use this form to revoke your insurance application (your declaration of contract) within the statutory revocation period. Please note that this declaration solely constitutes the revocation of your application and does not constitute the termination of a contract. Once you have submitted your revocation, you will receive an acknowledgement of receipt, and once your revocation has been processed, you will receive confirmation at the email address provided.

Reference number of your application *

You can find this number in the confirmation email you received after submitting your application, as well as in the application documents you downloaded.

Personal details

First name *

Last name *

Email *

I hereby revoke my insurance application as set out above.