[First name Surname]
[Street and house number]
[Postcode and town]

[Name of current health insurer]
[Insurer’s address]

[Place, date]

Subject: cancellation of compulsory basic insurance with effect from 31.12.2026

Dear Sir or Madam,

I hereby cancel my compulsory health insurance under the Swiss Health Insurance Act (KVG/LAMal) with effect from 31 December 2026, within the required notice period.

My insurance number is: [Insurance number].

From 1 January 2027, I will have basic insurance with another health insurer.

Please confirm the cancellation to me in writing.

Any supplementary insurance policies are expressly unaffected by this cancellation.

Yours faithfully,

[First name Surname]
[Signature]