Cancellations - Logging - Dis-Chem Life

Retentions

Submitted By(Required)

Did you call the client?(Required)

Client services: look up the policy number here to see if you need to call the client or not.

Ops team: if you want to just cancel a policy then select yes.

Source of Request(Required)

Policy Number(Required)

First Name of Person Requesting Cancellation(Required)

Surname of Person Requesting Cancellation(Required)

Phone Number of Person Requesting Cancellation

Email of Person Requesting Cancellation

Date of Cancellation Request(Required)

Time of Cancellation Request(Required)

Outcome(Required)

Cancellation Reason(Required)

Retained Reason(Required)

Comment(Required)

Escalation Required?(Required)