We believe the court will grant our request for leave to withdraw from your case. Applicant acknowledges and agrees that: (a) the Administrator has jurisdiction and authority to enter this Administrative Consent Order; (b) the.Provide Form 16 along with verification that there are no active policies being written. Completed NAIC UCAA Statement of Dissolution (Form 16). The purpose of a disengagement letter is to provide notice and document that the firm is withdrawing from an active matter. In this article, we'll explain when and how you should terminate your lawyer-client relationship. We'll even provide a sample termination letter. A. Relevant information and statutory provisions, under the Michigan Uniform. Be Clear: Be direct and get straight to the point. Clearly state that you are terminating the attorney and briefly state the reasons why.