Holiday Cancellation Form Non-urgent advice: Please noteYou will be required to drop off or email the claim forms given by your insurer for this request to be processed – iscicb-fw.thorntonpractice@nhs.net. Fees apply Full Name Date of Birth Day Month Year Today's Date Day Month Year Date insurance was purchased (or renewed) Day Month Year Date you booked the holiday Day Month Year Date you cancelled the holiday Day Month Year The dates you were supposed to be on the holiday Did a health professional advise you to cancel or did you make the decision yourself? If a health professional advised you, please say who it was and the date the advice was given. Optional What was the reason the cancellation was needed? Please tell us anything else you think is relevant Optional
