Notice for Non-Renewal of Insurance Policy - Form

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Contact No.: ________
Email: ________

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Attention: ________

Re: Notice of Non-Renewal of Life Insurance Policy No. ________

Dear Sir/Madam,

I. PURPOSE OF THIS NOTICE

1.1. I, the undersigned, ________, of legal age, with residence at ________ (the “Policyholder”), respectfully serve upon ________ (the “Insurer”) this written notice of my firm intention not to renew the above-referenced Life Insurance Policy.

1.2. This Notice is issued pursuant to and in accordance with the terms and conditions of the said Policy, the pertinent provisions of Republic Act No. 10607 (the Insurance Code of the Philippines, as amended), the relevant Circular Letters of the Insurance Commission, and the applicable provisions of the Civil Code of the Philippines (Republic Act No. 386).

II. PARTICULARS OF THE POLICY

2.1. Type of Policy: Life Insurance Policy.

2.2. Policy Number: ________.

2.3. Date of Issuance/Effectivity: ________.

2.4. Name of Insured: ________.

2.5. Date of Expiration: ________.

2.6. A true and faithful copy of the Policy is attached hereto and made an integral part of this Notice for your ready reference.

III. COMPLIANCE WITH THE NOTICE PERIOD

3.1. Under the terms of the Policy, a notice of non-renewal must be served upon the Insurer at least the following period prior to the expiration of the contract: ________.

3.2. This Notice is hereby served within the period prescribed by the Policy and by applicable law, and accordingly constitutes timely and sufficient notice for all intents and purposes.

IV. EFFECT OF NON-RENEWAL

4.1. By reason of the foregoing, the Policyholder hereby gives notice that the Policy shall not be renewed and shall instead terminate upon its natural date of expiration on ________, after which date the Insurer shall be under no further obligation to provide coverage thereunder.

4.2. Nothing in this Notice shall be construed as a waiver of any right, claim, or benefit which has accrued or may accrue to the Policyholder or to any beneficiary under the Policy prior to or upon its termination.

V. CLAIM FOR AMOUNTS DUE

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5.2. Kindly remit such amounts to the following account/address within the period prescribed by law and by the Policy: ________.

VI. REQUEST FOR ACKNOWLEDGMENT

6.1. Please confirm in writing your receipt of this Notice and the effective termination of the Policy upon its expiration date.

6.2. Should you require any additional information or documentation to process this non-renewal and the release of the amounts due, kindly inform me at the contact details set out above.

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Thank you for your prompt attention to this matter.

Respectfully yours,

______________________________
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Policyholder

ACKNOWLEDGMENT OF RECEIPT

Received the original of the foregoing Notice of Non-Renewal this ________ at ________.

______________________________
Name: ________
Designation: ________
For and on behalf of ________