TEST – Kanselasie/ Cancelation

AANSTELLING OM FINANSIËLE DIENSTE TE LEWER

POLICY NUMBER

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Fax nr
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TO WHOM IT MAY CONCERN / AAN WIE DIT MAG AANGAAN

Dear Sir / Madam

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Your First Name
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Your Last Name
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hereby appoint INTFIN, to be my broker on my accounts and concerns as detailed below. I also authorize the said Company to cancel my insurance policy.

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Cancelled from
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Business Name
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Initials
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Surname
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ID_Number
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Tel nr. Work
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Cell
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Home
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e-mail
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P.O Box
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Insurer
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Policy number
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Yours faithfully

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AUTHORIZED SIGNATORY
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Select a date
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Submit