The California Department of Insurance's requirements for withdrawal as an insurer from California are set forth in California Insurance Code §§1070-1076. The application to withdraw from California as an underwritten title company includes the following documents and forms.Provide Form 16 along with verification that there are no active policies being written. Completed NAIC UCAA Statement of Dissolution (Form 16). People with Medicare premium Part A or B who would like to terminate their hospital or medical insurance coverage. IMPORTANT NOTICE - This is a request to withdraw your application. If we approve it, the decision we made on your application will have no legal effect. Review and complete Unforeseeable Emergency Requirements to determine if you are ELIGIBLE to take a unforeseeable emergency withdrawal. Download Form 521: Request for Withdrawal of Application (PDF). Then, find the Social Security office closest to your home and mail us the completed form.