Dear …

Re: __(Type of Benefit/Insurance Plan/Policy - )__ - __(Reference Name/Policy #)__

Please allow this letter to serve as __(Name of Organization’s)__ official written request to cancel the above mentioned __(Type of Benefit/Insurance Plan/Policy - )__ effective__(date)__. We have chosen to exercise our right to allow this __(policy/plan)__ to expire on __(date)__. As outlined in the terms of our __(contract/agreement/policy)__, this written notification is well within the __(#)__ days required for notice of termination.

We thank you for your past service and look forward to receiving your acknowledgement of this request.

Yours truly,