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Place Date:  
Subject: Cancellation of insurance with OOM
Dear madam, sir,
I hereby inform you that I wish to terminate the above insurance as of .
If the stated date is not correct, I request that you use the correct contract expiry date. This cancellation will then take effect on that date.
I request that you confirm this cancellation,
Yours sincerely,
Initials + name: 
Street + house number: 
Postal code + City: 
Account number for possible OOM premium refund: 

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