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Get Electronic Declaration Of Surrender Form For Certificates Of Insurance

Electronic Declaration of Surrender Form for Certificates of Insurance This form is to be completed if you wish to cancel your KGM motor policy or if you have been notified that your policy has been cancelled. Once you have completed this form you must submit it electronically to the e-mail or website address your Broker has provided within seven days of the cancellation date. If you require any assistance in completing or submitting this form then please contact your Broker. Completion of this form is an alternative method of the requirement to return the hard copy of Vehicles Electronic Communication of Certificates of Insurance Order 2010 which came into force on 30 April 2010. This form can be utilised to surrender either a hard copy or an electronic Certificate of Insurance. Completion of this form declares that you are surrendering your current Certificate of Insurance as cover is no longer required* Please note that no cover will be in force from the date this document is submitted and details of the vehicle s insured under the policy will be removed from the Motor Insurance Database. Section 147 of the Road Traffic Act 1988 KGM Motor Insurance Policy Number Policyholder s name Vehicle registration number I confirm that the policy to which the Certificate of Insurance relates has ceased to have effect as from the date and time below. Date Time Notes The use of this form means that your policy is cancelled* It will be deleted from the Motor use your vehicle without a valid policy you will be committing an offence. The declaration must be submitted to KGM Motor Insurance or your Broker within seven days of the cancellation date. Failure to comply with this requirement is an offence under Reference to the availability of this form is contained in your Policy Document within the General Conditions section under the sub-heading Cancellation. Canopius Managing Agents Limited is a managing agent at Lloyd s and is authorised and regulated by the Financial Services Authority FSA Registration No* 204847. Canopius Managing Agents Limited is registered in England Wales number 01514453. Registered office Gallery 9 One Lime Street London EC3M 7HA. If you require any assistance in completing or submitting this form then please contact your Broker. Completion of this form is an alternative method of the requirement to return the hard copy of Vehicles Electronic Communication of Certificates of Insurance Order 2010 which came into force on 30 April 2010. Completion of this form is an alternative method of the requirement to return the hard copy of Vehicles Electronic Communication of Certificates of Insurance Order 2010 which came into force on 30 April 2010. This form can be utilised to surrender either a hard copy or an electronic Certificate of Insurance. This form can be utilised to surrender either a hard copy or an electronic Certificate of Insurance. Completion of this form declares that you are surrendering your current Certificate of Insurance as cover is no longer required* Please note that no cover will be in force from the date this document is submitted and details of the vehicle s insured under the policy will be removed from the Motor Insurance Database.

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