Provide the details and we will take care of the cancellation with H&L Assuradeuren.
First name
Next
Press ENTER
Last name
Next
Press ENTER
Email
Next
Press ENTER
Address
Next
Press ENTER
ZIP/postal code
Next
Press ENTER
City
Next
Date of birth
Next
Press ENTER
Reason for cancelling (optional)
Next
Press ENTER
Email for cancellation confirmation
Next