Transcription of CANCELLATION REQUEST / POLICY RELEASE - sls-ins.com
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CANCELLATION REQUEST / POLICY RELEASE - sls-ins.com
The ACORD name and logo are registered marks of ACORDPOLICY NUMBERCANCELLED POLICY INFORMATIONEXPIRATION DATEEFFECTIVE DATEPOLICY TERMEFFECTIVE DATE ANDHOUR OF CANCELLATIONPMAMTIMECANCELLATION DATEINSURED NAME AND ADDRESSNAIC CODE: POLICY TYPECOMPANY NAME AND ADDRESSAGENCYCUSTOMER ID:SUB CODE:CODE:(A/C, No, Ext):PHONEPRODUCERCANCELLATION REQUEST / POLICY RELEASEDATE (MM/DD/YYYY)This representation is true and accurate, and I understand that any misrepresentation may be deemed a fraudulent act.(Not applicable in NH per RSA 412:5 I)DATETITLEAUTHORIZED SIGNATUREPOLICY RELEASE (Complete SIGNATURES section below) CANCELLATION REQUEST ( POLICY attached)Any premium adjustment will be made in accordance with the terms and conditions of the this POLICY for losses which occur af
The ACORD name and logo are registered marks of ACORD POLICY NUMBER CANCELLED POLICY INFORMATION EFFECTIVE DATE EXPIRATION DATE POLICY TERM EFFECTIVE DATE AND
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