Flood Insurance Processing Center
PO Box 2057
Kalispell MT 59903
Phone: 800-637-3846
Date:
Insured Name:
Property Address:
Policy #:
VERIFICATION OF NO FLOOD INSURANCE REQUIREMENT
The NFIP has lifted the requirements for many documents previously required to cancel a flood policy.
By completing the information below, your policyholder is now able to cancel their flood policy with just
this document. Please have the policyholder complete, sign and date and return to our office with the
agent signature so we may complete the cancellation.
I, ___________________________________________, am not required by a lender, loss payee, landlord
or any Federal agency to maintain flood insurance through the NFIP for the property referenced above,
pursuant to any statute, regulation, or contract, and I am aware that by canceling my coverage, I may
lose eligibility for any subsidized premium rates made available through the NFIP.
Check the reason that best applies:
Property closing did not occur
Coverage no longer required by lender for a
detached structure
Policy not required by mortgagee due to a
revised zone determination by mortgagee
Duplicate coverage under a Non-NFIP policy
Insurance no longer required based on
FEMA review of lender’s determination by
means of a Letter of Map Determination
Voidance prior to the policy effective date
Mortgage paid off on a Mortgage Portfolio
Protection Program Policy
Insurance no longer required by the
mortgage as the building is determined to
be outside the SFHA by means of a Letter of
Map Amendment
Insurance no longer required by mortgagee
as the property is no longer in a Special
Flood Hazard Area due to physical map
revision
Per the box marked above, I hereby authorize the cancellation of my flood policy: (all named insureds
must sign)
________________________________________
________________________________________
Additional Named Insured (printed)
________________________________________
________________________________________
Insured Signature and Date
Additional Named Insured Signature and Date
PURSUANT to 28 U.S.C. § 1746 I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES OF AMERICA THAT THE FOREGOING IS
TRUE AND CORRECT. I UNDERSTAND THAT ANY FALSE STATEMENTS MAY CAUSE MY POLICY TO BE VOID, AND MAY BE PUNISHABLE BY FINE OR
IMPRISONMENT UNDER APPICABLE FEDERAL LAW.
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
