Agency Staff Articles2 min read

How to Complete the ACORD Cancellation Form - ACORD 35

A field-by-field guide to the ACORD cancellation form: dates, reason, method of cancellation, return premium, signatures, and the mistakes that delay a refund.

By Justin Goodman, Co-Founder and CEO, Total CSRPublished Updated
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This ACORD form is what an insured signs to ask the insurer to end or release a policy. Account managers use it to record an insured-requested cancellation, set the cancellation timing, and tell the insurer how to calculate any premium refund.

What the ACORD 35 Form Does

It puts the cancellation details in one signed record for the insurance company to review, which reduces administrative work and speeds up cancellation.

Policy Cancellation Request or Lost Policy Release Form

  • Two boxes at the top: request cancellation, or release the policy.

Why Some Carriers Say LPR Insurance Form

  • The release side grew out of the old lost-policy statement.

How to Fill Out the ACORD Cancellation Form

Insurer and Agency

  • Company name and address, NAIC code, producer and agency customer ID.
  • The insurer's mailing address and the agency's contact details.

Insured and Policy

  • Insured name and address as the policy documents show it.
  • Policy type and number, effective date and expiration date.
  • All named insureds; carriers often want each to sign.

Dates and Time

  • Effective cancellation date and time, AM or PM.
  • Avoid ambiguous dates; stay within the policy term.

Reason

  • Mark one reason for cancellation: not taken, requested by insured, rewritten, or other.
  • Rewritten: replacement of policy or switching insurance carriers.
  • Other: sale of insured property, business closure, change in risk profile.
  • Example: a construction firm sells the enterprise covered.
  • A non-renewal by insurer reflects underwriting criteria and uses the carrier's notice.
  • Non-payment of premiums also uses the carrier's notice.

Method and Premium

  • Method of cancellation: flat cancellation, pro rata, or short rate.
  • Full term premium, unearned factor, and return premium.
  • Minimum premium requirements can shrink the unused premium returned.

Signatures and Distribution

  • Signature of named insured, date, and a witness signature if required.
  • Lienholders, a mortgagee, or a loss payee may need an authorized signature.
  • Distribution boxes, so interested parties with notification requirements get copies.
  • For vehicles, check department of motor vehicles rules and regulatory changes.
  • The insurance producer signs the producer section.

Mistakes to Avoid

  • Incorrect policy numbers and missing signatures stall processing.
  • Incomplete lienholder information can leave a lender uninformed.
  • Use a standardized checklist and a double-check system.
  • Unclear forms invite coverage disputes and costly litigation.
  • Type into an ACORD cancellation form fillable PDF and keep the cancellation documentation.

Your browser cannot display this PDF inline.

ACORD 35 – Cancellation Request (PDF, 1 page)

Frequently Asked Questions

Who signs the ACORD cancellation form?

The named insured signs; carriers often want every named insured to sign. Lenders sign only when required. Match the policyholder information to the declarations page.

Is an LPR form the same document?

Mostly. The form combines the older policy release statement with a cancellation request, so insurance professionals use both names. Check which box the insured marked before sending it.

Can the form be used for policy changes?

No. New coverage levels, drivers, or locations go on a change request, not a cancellation request form. The wrong form can end coverage the insured meant to keep.

Should the insured have replacement coverage in place first?

Yes, if protection is still needed. Start the new policy on or before the cancellation date so coverage has no gap.

Can a carrier refuse insurance cancellation requests?

Rarely. Standard policy conditions let the first named insured cancel by written notice; the policy agreement mainly sets the timing and refund method.

Justin Goodman

Co-Founder and CEO, Total CSR

With two decades of experience in the insurance industry, Justin is the co-founder and CEO of Total CSR and the co-founder and Managing Director of Project 55. By the age of 29, Risk and Insurance Magazine recognized him as one of the nation’s top five construction insurance experts. He has also been named to Insurance Business Magazine’s Hot 100 and was most recently honored as the 2024 Insurance Journal Agent of the Year.

Through his leadership at Total CSR, Justin has trained more than 100,000 CSRs, account managers, and producers, driven by his passion for developing the next generation of insurance professionals. When not spending time with his family, he dedicates his free time to speaking at industry events and advising agency owners across the country.

Connect with Justin on LinkedIn