REQUEST FOR POLICY CANCELLATION

Insurer :- Intact Insurance Company of Canada

Policy Number :- KG94QR372A
Insured :- Omar Bidar
Brokerage :- All-Risks Insurance Brokers Limited
Effective Date of Cancellation :- MARCH 15 2023 AT 12:01AM

In consideration of the return of earned premium to follow (if any) and in accordance with the terms of the policy
I/we hereby request cancellation of the policy as identified above and effective as of 12:01 A.M. of the date shown
above. This policy is hereby cancelled and surrendered, and the interim renewal certificate (if any has been issued)
for same, acknowledged to be of no effect. I/We hereby release the above insurer from all liability under this
policy, including any renewal thereof, as from the aforementioned date of cancellation.
Signed electronically by

Omar Bidar
Signature: _______________________________
on Mar 17, 2023 - 12:51 PM GMT

Of Omar Bidar
Omar Bidar
Insured(s): _______________________________

Note: If any return of unearned premium is due please be advised that refund may require three to six weeks to
process. A cheque will be forwarded once cancellation has been confirmed by the insurer.

(613) 416-1513 | (855) 552-7329

www.all-risks.com/orleans
123B-880 Taylor Creek Dr,Orleans, ON K4A 0Z9

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