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<form id="azpCancellationForm" action="#" method="post">
  <div class="frmLabel">Policy Number:</div>
  <div class="frmValue">AMR19218488853</div>
  <div class="frmLabel">Purchase Date:</div>
  <div class="frmValue">06/23/2022</div>
  <input type="hidden" name="pd" id="pd" value="06/23/2022">
  <input type="hidden" name="pn" id="pn" value="AMR19218488853">
  <input type="hidden" name="fn" id="fn" value="Kelli">
  <input type="hidden" name="s" id="s" value="VA">
  <div><input name="btnSubmit" id="btnSubmit" type="submit" value="Cancel My Policy"></div>
  <div id="disabledMsg"></div>
</form>

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THANKS FOR CHOOSING ALLIANZ GLOBAL ASSISTANCE

Cancel your Policy
As part of our commitment to our customers, we are offering you the option to
easily cancel your policy and receive a refund of the cost of your premium. To
proceed, please verify the below information and click ‘Cancel My Policy’.
Policy Number:
AMR19218488853
Purchase Date:
06/23/2022



Terms, conditions, and exclusions apply to all plans. Benefits and limits vary
by plan. For a complete description of the coverage and benefit limits offered
under your specific plan, carefully review your plan’s Letter of
Confirmation/Declaration of Coverage and Certificate of Insurance/Policy.
Insurance benefits underwritten by BCS Insurance Company, or Jefferson Insurance
Company, depending on your state of residence and plan chosen. Plans only
available to U.S. residents and may not be available in all jurisdictions.
Allianz Global Assistance and Allianz Travel are marks of AGA Service Company
dba Allianz Global Assistance or its affiliates.Allianz Travel, Event Ticket,
and Registration insurance products are distributed by Allianz Global
Assistance, the licensed producer and administrator of these plans and an
affiliate of Jefferson Insurance Company. The insured shall not receive any
special benefit or advantage due to the affiliation between Allianz Global
Assistance and Jefferson Insurance Company. Plans include insurance benefits and
assistance services. Any Non-Insurance Assistance services purchased are
provided through Allianz Global Assistance. Any non-insurance travel
cancellation fee waiver purchased is provided by the travel supplier from whom
you purchased that travel cancellation fee waiver. Except as expressly provided
under your plan, you are responsible for charges you incur from third parties.

Copyright © 2022 AGA Service Company. All rights reserved.

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