Mpp cancellation form 2026

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  1. Click ‘Get Form’ to open the mpp cancellation form in the editor.
  2. Begin by entering your first and last name in the designated fields at the top of the form.
  3. Fill in your address, including city, state, and zip code. Ensure accuracy for processing.
  4. Provide your area code and phone number, followed by your email address for communication purposes.
  5. Next, input details about your vehicle: year, make, model, and the last six digits of the Vehicle ID Number (VIN).
  6. Indicate whether there is currently a lien on the vehicle by checking 'Yes' or 'No'. If yes, include lienholder information.
  7. Select all plans you wish to cancel by checking the appropriate boxes. Ensure no boxes are left blank.
  8. State your reason for cancellation by checking one of the provided options and attach any necessary documentation as specified.
  9. Finally, sign and date the form at the bottom. If applicable, have a dealer representative sign as well.

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CANCELLATION AND REFUND Provided there are no claims made under this Agreement, YOU may return this Agreement to the Administrator within thirty (30) days of purchase for a full refund of the amount paid, less the cancellation fee.
By calling Health Connector Customer Service at 1-877-MA-ENROLL (1-877-623-6765), or TTY 711 for people who are deaf, hard of hearing, or speech disabled. Special note: If you are canceling your plan over the phone, the request should be made no later than 2 hours before the close of business on the 23rd of the month.
A cancellation request form allows the request of cancellation of a service, subscription, reservation, or an order, streamlining the cancellation process and ensuring that the request is handled in an organized and efficient manner.