Fema Cancellation Form PDF Details

Navigating the process of cancelling a flood insurance policy through the National Flood Insurance Program (NFIP) can seem daunting, but understanding the FEMA Cancellation/Nullification Request Form is a crucial step. This form, a tool provided by the U.S. Department of Homeland Security’s Federal Emergency Management Agency (FEMA), outlines the necessary details and procedures for policyholders wishing to cancel or nullify their flood insurance coverage. At the heart of this procedure are key inputs such as policy numbers, period of coverage, and details surrounding the insured property and mortgagee information. Moreover, the form lists diverse reasons for cancellation, ranging from the sale or alteration of the insured building to more complex situations like map revisions or lender determinations eliminating the need for coverage. Refund preferences are also addressed, allowing policyholders to direct refunds to insured individuals, payors, or agents under specific conditions. With a strong emphasis on accuracy and the provision of correct information, the form underscores the seriousness of false statements under federal law. Furthermore, it is accompanied by a commitment to nondiscrimination and adheres to various privacy and information collection standards aimed at protecting individuals’ data and ensuring program integrity. As such, the FEMA Cancellation/Nullification Request Form plays a pivotal role for policyholders navigating their flood insurance needs in alignment with changing circumstances or new information.

QuestionAnswer
Form NameFema Cancellation Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesfema cancellation, flood cancellation form, flood reason fema latest, form flood federal

Form Preview Example

U.S. DEPARTMENT OF HOMELAND SECURITY

O.M.B. No. 1660-0006 Expires April 30, 2020

FEDERAL EMERGENCY MANAGEMENT AGENCY

 

National Flood Insurance Program

 

FLOOD INSURANCE CANCELLATION/NULLIFICATION REQUEST FORM

POLICY #:

 

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

 

 

POLICY

PERIOD

POLICY PERIOD IS FROM

/

/

 

 

TO

/

/

 

 

 

 

CANCELLATION EFFECTIVE DATE:

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AGENT/PRODUCER

 

NAME AND MAILING ADDRESS OF AGENT/PRODUCER ON THE POLICY BEING CANCELED.

INFORMATIONINSURED

NAME AND MAILING ADDRESS OF INSURED FOR MAILING REFUND:

 

INFORMATION

AGENCY NO.:

 

 

 

 

AGENT’S TAX ID:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHONE NO.:

 

 

 

 

 

 

 

FAX NO.:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMAIL ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1STMORTGAGEE/

MORTGAGEEOTHER

NAME AND MAILING ADDRESS OF FIRST MORTGAGEE:

 

 

 

 

 

 

 

 

 

 

LOCATIONPROPERTY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHONE NO.:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSURED PROPERTY LOCATION:

 

 

 

 

 

 

 

 

 

 

LOAN NO.:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME AND MAILING ADDRESS OF OTHER PARTIES NOTIFIED:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2ND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N

F

I

CANCELLATION REASON CODES

CANCELLATION REASON CODE:

1.BUILDING SOLD OR REMOVED, DESTROYED OR PHYSICALLY ALTERED TO NO LONGER MEET THE DEFINITION OF AN ELIGIBLE BUILDING

2.CONTENTS SOLD OR REMOVED

3.POLICY CANCELED AND REWRITTEN TO ESTABLISH COMMON EXPIRATION DATE WITH OTHER INSURANCE COVERAGE

4.DUPLICATE NFIP POLICIES

5.NON-PAYMENT

6.RISK NOT ELIGIBLE FOR COVERAGE

7.PROPERTY CLOSING DID NOT OCCUR (NO INSURABLE INTEREST)

8.POLICY OBTAINED FOR PROPERTY CLOSING, BUT NOT REQUIRED BY MORTGAGEE AS PROPERTY NOT IN SFHA

9.INSURANCE NO LONGER REQUIRED BY MORTGAGEE; PROPERTY NO LONGER IN SFHA BECAUSE OF PHYSICAL MAP REVISION

10.CONDOMINIUM POLICY (UNIT OR ASSOCIATION) CONVERTING TO RCBAP

12.MORTGAGE PAID OFF

13.VOIDANCE PRIOR TO EFFECTIVE DATE

15.INSURANCE NO LONGER REQUIRED BASED ON FEMA REVIEW OF LENDER’S SFHA DETERMINATION (LODR)

18.MORTGAGE PAID OFF ON AN MPPP POLICY

19.INSURANCE NO LONGER REQUIRED BY THE MORTGAGEE BECAUSE THE BUILDING HAS BEEN REMOVED FROM THE SFHA BY MEANS OF A LOMA

20.POLICY WRITTEN TO WRONG FACILITY (SEVERE REPETITIVE LOSS PROPERTY)

21.OTHER: CONTINUOUS LAKE FLOODING OR CLOSED BASIN LAKES

22.CANCEL/REWRITE DUE TO MISRATING

23.FRAUD (FEMA APPROVAL REQUIRED)

24.CANCEL/REWRITE DUE TO MAP REVISION, LOMA, OR LOMR

25.CANCEL/REWRITE TO PROCESS HFIAA REFUND

P

C O P Y

REFUND

MAIL REFUND TO (CHECK ONE):

INSURED

PAYOR

AGENT (REASON 5

ABOVE OR AT REQUEST OF INSURED)

 

MAKE REFUND PAYABLE TO (CHECK ONE):

INSURED

PAYOR

AGENT (REASON 5

ABOVE ONLY)

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. SEE REVERSE SIDE OF COPIES 2, 3, AND 4.

SIGNATURE

 

 

 

 

/

 

 

/

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF INSURED

 

DATE (MM/DD/YYYY)

 

 

 

 

 

 

 

 

 

 

(NOT REQUIRED FOR REASON 5, 6, 22, OR 25)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

 

 

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/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF OTHER INSURED

 

DATE (MM/DD/YYYY)

 

 

SIGNATURE OF AGENT/PRODUCER

 

DATE (MM/DD/YYYY)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FEMA Form 086-0-2

Previously FEMA Form 81-17

F-052 (JUN 2015)

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

SPECIAL NOTE TO INSURANCE AGENT/PRODUCER: SEND ORIGINAL TO NFIP, KEEP SECOND COPY FOR YOUR RECORDS, GIVE THIRD COPY TO THE INSURED, AND FOURTH COPY TO MORTGAGEE.

National Flood Insurance Program

FLOOD INSURANCE CANCELLATION/NULLIFICATION REQUEST FORM

FEMA FORM 086-0-2

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 Act, on the grounds of race, color, creed, sex, age or national origin.

PRIVACY ACT

The information requested is necessary to process your Flood Insurance Application for a flood insurance policy. The authority to collect the information is Title 42, U.S. Code, Sections 4001 to 4028. Disclosures of this information may be made: to federal, state, tribal, and local government agencies, fiscal agents, your agent, mortgage servicing companies, insurance or other companies, lending institutions, and contractors working for us, for the purpose of carrying out the National Flood Insurance Program; to current Severe Repetitive Loss property owners and Preferred Risk Policy owners for the purpose of property loss history evaluation; to the American Red Cross for verification of nonduplication of benefits following a flooding event or disaster; to law enforcement agencies or professional organizations when there may be a violation or potential violation of law; to a federal, state or local agency when we request information relevant to an agency decision concerning issuance of a grant or other benefit, or in certain circumstances when a federal agency requests such information for a similar purpose from us; to a Congressional office in response to an inquiry made at the request of an individual; to the Office of Management and Budget (OMB) in relation to private relief legislation under OMB Circular A-19; and to the National Archives and Records Administration in records management inspections. Providing the information is voluntary, but failure to do so may delay or prevent issuance of the flood insurance policy.

GENERAL

This information is provided pursuant to Public Law 96-511 (Paperwork Reduction Act of 1980, as amended), dated December 11, 1980, to allow the public to participate more fully and meaningfully in the Federal paperwork review process.

AUTHORITY

Public Law 96-511, amended, 44 U.S.C. 3507; and 5 CFR 1320.

PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to average 7.5 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 respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. 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, 500 C Street SW, Washington, DC 20742, Paperwork Reduction Project (1660-0033). NOTE: Do not send your completed form to this address.

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