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Flood Insurance Cancellation/Nullification Request Form

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Flood Insurance Cancellation/Nullification Request Form

U.S. DEPARTMENT OF HOMELAND SECURITY | FEDERAL EMERGENCY MANAGEMENT AGENCY

National Flood Insurance Program

OMB No. 1660-0006 | Expires May 31, 2024

IMPORTANT – PLEASE PRINT OR TYPE; ENTER DATES AS MM/DD/YYYY.

POLICY PERIOD

Policy Period is From

To

POLICYHOLDER INFORMATION


Phone No.:

Email Address:

AGENT/PRODUCER INFORMATION


Agency No.:

Agent No.:

Phone No.:

Email Address:

PROPERTY LOCATION


FIRST MORTGAGEE INFORMATION


SECOND MORTGAGEE / OTHER INFORMATION

Information Below is That of:

CANCELLATION REASON CODE

Please see all valid cancellation reason codes and requirements for their use in the “How to Cancel” section of the NFIP Flood Insurance Manual on the FEMA website.

https://www.fema.gov/flood-insurance-manual

REFUND

Make Refund Payable To (check one):

Mail Refund To (check one):

The above statements are correct to the best of my knowledge. I understand that any false statements may be punishable by fine and/or imprisonment under applicable federal law.

SIGNATURE OF POLICYHOLDER

DATE

SIGNATURE OF POLICYHOLDER

DATE

SIGNATURE OF AGENT/PRODUCER

DATE

FEMA FORM FF-206-FY-21-118 (FORMERLY 086-0-2) (05/2021)

PLEASE ATTACH ALL REQUIRED DOCUMENTS TO NFIP COPY OF CANCELLATION/NULLIFICATION REQUEST FORM.

SEND ORIGINAL TO NFIP, KEEP A COPY FOR YOUR RECORDS, AND PROVIDE COPIES TO THE POLICYHOLDER AND MORTGAGEE(S).

NONDISCRIMINATION

No person or organization shall be excluded from participation in, denied the benefits of, or subjected to discrimination under the Program authorized by the National Flood Insurance Act of 1968, on the grounds of race, color, creed, sex, age, or national origin.

PRIVACY ACT

Authority: 42 U.S.C. 4011 et seq. authorizes the collection of this information.

Purpose: FEMA will use this information to issue flood insurance policies provided through the National Flood Insurance Program.

Routine Uses: The information requested on this form may be shared externally as a “routine use” to other federal agencies, state governments, local governments, tribal governments, certain non-profit entities, private insurance companies participating in the Write Your Own Program, and their contractors to implement the National Flood Insurance Act of 1968. A complete list of the routine uses can be found in the system of records notice associated with this form, “DHS/FEMA-003 National Flood Insurance Program Files” (79 FR 28747). The Department’s full list of system of records notices can be found on the Department’s website at http://www.dhs.gov/system-records-notices-sorns.

Disclosure: Furnishing this information is voluntary. However, failure to furnish the requested information may delay or prevent the issuance of a flood insurance policy.

PAPERWORK REDUCTION ACT NOTICE

Public reporting burden for this form is estimated to average 6 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the form. This collection of information is required to obtain or retain benefits. You are not required to submit to this collection of information unless it displays a valid OMB control number. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency (FEMA), 500 C Street SW, Washington, DC 20472. NOTE: Do not send your completed form to this address.

U.S. DEPARTMENT OF HOMELAND SECURITY | FEDERAL EMERGENCY MANAGEMENT AGENCY

National Flood Insurance Program

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What the Flood Insurance Cancellation/Nullification Request Form Is

The Flood Insurance Cancellation/Nullification Request Form is a formal written instruction sent by a policyholder or an authorized representative to an insurer or mortgagee asking to terminate an active flood insurance policy or to nullify a recently issued policy. This form documents the policy number, named insured, property address, requested effective cancellation date, and the reason for cancellation or nullification (for example, policy replacement, transfer of ownership, duplicated coverage, or lender release). Insurers use the completed form to process refunds, adjust billing, and notify mortgage lenders where applicable.

Why this form matters for policyholders and lenders

Using a dedicated Flood Insurance Cancellation/Nullification Request Form creates a clear record of intent, reduces disputes about cancellation timing, and helps preserve refund or premium adjustment rights when coverage ends.

Why this form matters for policyholders and lenders

Who completes or receives this form

Typical participants include the named policyholder, mortgage servicer, insurance agent, and insurer cancellations unit.

  • Policyholders and authorized agents who request termination of flood coverage with the insurer or agent
  • Mortgage lenders or servicers that require notice when flood insurance tied to collateral is changed or canceled
  • Insurance agents or brokers who submit cancellations on behalf of insureds and manage refund reconciliation

Ensure each recipient gets a signed copy and retain the insurer's acknowledgment to confirm effective cancellation and refund processing.

Core elements that make a professional cancellation request

A complete Flood Insurance Cancellation/Nullification Request Form contains identity data, policy identifiers, specific cancellation instructions, signature and authority verification, and routing instructions for refund and lender notice.

Policy Identifiers

Policy number, effective and expiration dates, and insurer name to ensure the correct contract is targeted for cancellation and to avoid processing errors.

Named Insured

Full legal name of the policyholder as shown on policy documents, plus any additional insured or mortgagee names required for lender or agent notification.

Property Details

Property address including unit number, city, state, and ZIP; flood map or NFIP community number if available to confirm the insured risk location.

Cancellation Instructions

Clear requested effective date, reason for cancellation or nullification (for example, duplicate policy or replacement policy), and whether a refund or premium proration is requested.

Authority and Signature

Signature block demonstrating the signer’s authority (policyholder, agent, or authorized representative) with printed name, title, and date to validate the request.

Routing and Acknowledgment

Designated contact for refund processing, optional mortgagee notification instructions, and a place for insurer acknowledgment or effective cancellation date.

Required data fields at a glance

Policy Number: Unique insurer policy ID
Named Insured: Legal name on policy
Property Address: Street, city, state, ZIP
Requested Date: MM/DD/YYYY effective date
Reason: Cancellation or nullification reason
Signature: Authorized signer and date

Step-by-step: completing and submitting the request

Follow these sequential steps to complete a Flood Insurance Cancellation/Nullification Request Form and help ensure timely insurer processing and refund handling.

  • 01
    Collect documents: Gather the declarations page and mortgagee clause information.
  • 02
    Complete form: Enter policy, property, effective date, and reason.
  • 03
    Sign and verify: Obtain authorized signature and date in required format.
  • 04
    Submit and confirm: Send to insurer and retain acknowledgment of effective date.

Common online configuration for digital completion

When using a digital form, configure fields and authentication to match insurer and lender requirements to reduce rejections.

Field Configuration
Policy Number Field Mandatory text field, exact-match validation
Effective Date Field Date picker in MM/DD/YYYY format
Signature Field Signer must check authority and provide e-signature
Lender Notification Optional checkbox to request mortgagee copy

Where the completed form is sent and how it's processed

A completed request typically moves from the policyholder to the insurer, with copies to the agent and mortgagee if required; each recipient performs a standard verification and updates coverage records.

  • Insurer Cancellations Unit: Receives form and verifies policy details.
  • Agent/Broker: Confirms authorization and forwards to insurer.
  • Mortgagee/Lender: Receives notice if policy secures a loan.
  • Acknowledgment: Insurer returns an effective date and refund details.

Digital submission: platform and security considerations

Use platforms that support secure upload, audit trails, and evidence of signer identity when submitting cancellation requests electronically.

  • File formats: PDF and DOCX accepted
  • Authentication: Email, SMS code, or ID verification
  • Audit trail: Time-stamped events required

Choose a solution that aligns with insurer or lender requirements for identity and retention; ensure the platform supports secure storage and exportable audit records for dispute resolution.

Typical timelines and processing expectations

Processing times vary by insurer, but a clear acknowledgment with an effective cancellation date is essential to determine proration and refund timing.

Insurer Acknowledgment:

Expect written acknowledgment within 7–30 business days

Refund Processing:

Refunds commonly processed within 30–60 days

Mortgagee Notification:

Lender notified immediately or within insurer cycle

Backdating Requests:

Subject to insurer rules; may be denied

Effective Date Disputes:

Retain acknowledgments to resolve timing disputes

Common mistakes that delay or void requests

  • Submitting incomplete policy identifiers which causes insurer to process the wrong account and delay refunds
  • Using an incorrect effective date or ambiguous instructions that cause disputes about when coverage ended
  • Failing to obtain or document signer authority, leading the insurer to request additional proof of authorization
  • Not notifying the mortgagee when required, which can trigger force-placed insurance or lender penalties

Risks and potential consequences of incorrect requests

Coverage Gap: Loss of protection
Force-placed Insurance: Higher premiums charged by lender
Refund Delay: Extended processing times
Disputed Effective Date: Payment or liability disputes
Administrative Rejection: Form returned incomplete
Legal Exposure: Liability for uncovered losses

Real-world examples of completing cancellations

These abbreviated examples show how organizations document cancellations and the practical outcomes of proper completion and submission.

Martin Properties – Tim Martin

A regional broker filed a cancellation to remove duplicate coverage after closing

  • The broker used a dated effective date to match escrow instructions
  • The insurer issued a prorated refund within 30 days and provided a routed acknowledgment to the mortgagee that avoided force-placed coverage.

Fertility Centers of Illinois – John Butler

A healthcare facility replaced an expiring flood policy with a new insurer

  • The authorized agent submitted a nullification request including both policies' numbers
  • The new insurer accepted the effective date and the prior policy was nullified, preventing a coverage gap for sensitive patient-care facilities.

eSignature vendor comparison for completing the form (signNow first)

Basic vendor pricing and feature availability relevant to completing and delivering Flood Insurance Cancellation/Nullification Request Forms; feature availability may vary by plan and vendor.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies Varies Varies Varies
Bulk Send Yes Varies Varies Varies Varies
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Varies Varies Varies Varies
Envelope Cap No cap 100 envelopes/user/year Varies Varies Varies

Frequently asked questions and common troubleshooting

Answers to six common questions about completing, submitting, and validating Flood Insurance Cancellation/Nullification Request Forms.


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