Acknowledgement and Confirmation

By signing below, I confirm that I am requesting the cancelation of the above-referenced insurance policy/policies. I understand that:

• The policy will be canceled effective on the desired cancelation date or the date confirmed by the insurer, whichever is applicable.

• No coverage will be provided under this policy for any claims, incidents, or losses occurring after the effective cancelation date.

• I have reviewed the terms of the policy regarding cancelations, including any applicable refund provisions, and agree to those terms.

• A request to cancel a homeowner's policy prior to the Company's non-renewal date may forfeit the right to any Cashback refund, which would have otherwise been received.