About this template
An ACORD cancellation form (often referred to as ACORD 35) is the industry-standard document used by policyholders to formally request the cancellation of an existing insurance contract. Whether dealing with auto, home, commercial, or liability policies, insurance agencies and brokerages need a streamlined way to capture accurate policy release details from clients without cumbersome paperwork.
This digital ACORD cancellation template simplifies the collection of essential data, including policy numbers, NAIC codes, effective cancellation dates, and detailed reasons for termination. By standardizing this intake process, agencies can drastically reduce processing delays, eliminate missing information, and maintain clear audit trails for every policy change.
With Doc2Form, you can instantly turn this layout into a ready-to-use Google Form, embed it in your client portal, or email it directly to policyholders. Collected responses feed right into your preferred workflows, allowing your team to verify signatures, process refunds or pro-rated adjustments, and update carrier systems faster than ever.
Key features
- Capture policy numbers, NAIC codes, and carrier details accurately.
- Collect mandatory cancellation effective dates and times without friction.
- Standardize reasons for cancellation across all lines of insurance.
- Include fields for third-party interests and loss payee notifications.
- Review complete submissions directly in Google Sheets for easy tracking.
Use cases
- Commercial property and casualty policy terminations.
- Personal auto or homeowners insurance cancellations.
- Mid-term policy restructuring and broker of record changes.
- Insured-requested policy releases prior to renewal dates.
What this form collects
- Request Date (Date)Enter today's date.
- Insured Name (Short answer)Enter the full legal name of the individual or business insured.
- Email Address (Short answer)Provide a reliable email address for confirmation and correspondence.
- Phone Number (Short answer)Include your primary contact number.
- Mailing Address (Paragraph)Enter your current street address, city, state, and ZIP code.
- Insurance Company Name (Short answer)Enter the name of the issuing insurance carrier.
- NAIC Code (Short answer)Enter the 5-digit NAIC company code if known.
- Policy Type (Dropdown)Select the line of coverage being cancelled.
- Policy Number (Short answer)Enter your complete policy number.
- Agency ID / Code (Short answer)Enter the producing agency identifier if applicable.
- Cancellation Effective Date (Date)Select the date you wish the cancellation to take effect.
- Cancellation Effective Time (Short answer)Enter the specific time of cancellation if required (e.g., 12:01 AM).
- Policy Term Effective Date (Date)The original start date of the current policy term.
- Policy Term Expiration Date (Date)The scheduled expiration date of the current policy term.
- Reason for Cancellation (Paragraph)Briefly explain why you are cancelling this policy.
- Cancellation Method (Multiple choice)Select how the cancellation is being initiated.
- Third-Party Name (Short answer)Name of the lienholder, mortgagee, or interested party.
- Third-Party Company & Address (Paragraph)Provide the institution name and mailing address for notices.
- Terms Acceptance (Multiple choice)By submitting this form, I certify that I am authorized to request the cancellation of the insurance policy listed above.
- Insured / Authorized Signature Name (Short answer)Type your full legal name as an electronic signature.
- Signing Date (Date)Enter the date of signature.
FAQ
What is an ACORD cancellation form?
An ACORD cancellation form is a standardized document used within the insurance industry by policyholders and agents to officially request the cancellation or release of an existing insurance policy.
Who is required to submit this form?
The named insured or an authorized representative typically must complete and sign the cancellation request to legally terminate the policy coverage.
What key details are needed to complete the cancellation?
You will need the primary policy number, insurance company name, NAIC code, agency ID, the exact effective date and time of cancellation, and the reason for terminating the contract.
Can I customize the questions for different types of insurance?
Yes. Once you convert this template into Google Forms via Doc2Form, you can easily add, remove, or modify sections to suit auto, home, or commercial lines.
Where are form submissions stored?
All responses are automatically organized in your connected Google Sheet, making it simple to export data or generate PDFs for agency records.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.