Termination letter
	Insured individual
	First name
	Name
	Street, No.
	Postal code / city or town
	Previous insurer
	Name of insurance company	Please select... Alba Allianz Suisse Allianz24.ch AXA Basler Baloisedirect smile CSS Insurance Emmental Generali Helvetia Mobiliar Nationale Suisse Vaudoise Visana AXA Winterthur Zurich Connect Zurich
	Policy	Please select... Private liability & household Private liability Household
	Policy number
	Reason for termination	Please select... Expiry of contract Increase of retention Increase of premiums Damage
	Termination deadline	Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Month January February March April May June July August September October November December   Year 2010 2011