Date:

To,
Insurance Company Name: Branch Address:

Subject:

Policyholder Name: Policy Number:

Dear Sir/Madam,

This is to request the surrender of my term life insurance policy as detailed above. I kindly request you to process the surrender and settle any surrender value, if applicable, to my registered bank account at the earliest convenience.

Please find enclosed all relevant documents as required.

Thank you.

Sincerely,

Signature: Name: Contact Details:

Term Life Insurance Surrender Request Letter