Revoke contract / application

Please use this form to withdraw your insurance application (your declaration of intent to enter into a contract) or your insurance contract within the statutory revocation period. Please note that this declaration solely constitutes the revocation of your application or contract 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.

Your insurance number or application reference number *

If you have already received an insurance confirmation, you will find your insurance number in it.

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

Personal details

First name *

Last name *

Email *

I hereby revoke my insurance contract or insurance application as set out above.