[Your Name]

[Your Address]
[City, State ZIP Code]
[Date]

[Immigration Authority Name]

[Immigration Authority Address]
[City, State ZIP Code]

Dear Sir/Madam,

I am writing to formally request the cancellation of my [Type of Visa] visa, which was issued on
[Date of Issue] and is valid until [Date of Expiry]. I am unable to continue with the terms and
conditions of the visa due to unforeseen circumstances, and thus wish to cancel the visa with
immediate effect.

To ensure that this request is legally binding, I have attached a notarized statement, affirming my
request for the cancellation of my visa. Additionally, I have provided a copy of my passport for
your reference.

I request that you kindly process the cancellation of my visa as soon as possible and inform me
of the same. I understand that there may be certain formalities that need to be completed before
the visa can be cancelled, and I am willing to comply with any requirements.

Thank you for your time and attention to this matter. If you require any further information or
documentation from my end, please do not hesitate to contact me.

Sincerely,
[Your Name]

Enclosures:
Notarized statement
Copy of passport