Free Dental Insurance Cancellation Letter [Sample]

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Learn how to write a dental insurance cancellation letter. Use our sample dental insurance cancellation letter as a template for your cancellation letter.

Dental Insurance Cancellation Letter Sample


Name on Policy
Address of Policy Holder
City, State, Zip

XYZ Insurance Company
Address of Company
City, State, Zip

ATT: Cancellations

RE: Dental Insurance Policy #

Please consider this letter as a formal request to cancel the referenced dental insurance policy. 

Please stop all debits or charges for premium payments. The effective date of policy cancellation is DATE.

I am also requesting written confirmation of the cancellation and the return of any premiums. The cash value of the policy should also be sent with any returned premium.

This action needs to occur within a period of 30 days from the receipt of this letter.


Name of Policy Holder

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