Contract Termination Request Form

HMA APPLICATION FOR CONTRACT TERMINATION REQUEST
Business Name in Full:*
Full Legal/Corporate Name*
Contact Person:*
Trading Name/Business Name *
(if different from above)
Postal Address:*
Post Code:*
Office Telephone:*
Format: (000) 000-0000.
Mobile Contact:*
Format: (000) 000-0000.
Website Address*
E-Mail Address:*
Certified products:*
Certified since:*
Reason for Termination of Certification/ Approval:*
I, the undersigned, hereby would like to terminate the contract with HMA, effective:*

MonthDayYear
I no longer wish to be approved by the HMA. Please cancel my contract.
I will fulfil my outstanding obligations in relation to HMA standards and service fees as per the contract.
Signature (Draw your signature below)*
Date*

MonthDayYear
Print Name:*
Position in Company / Outlet :*
Witness Signature (Draw your signature below)*
Print Name:*
Signature Name (for verification)*
Full Name
Please verify you are not a robot*
Should be Empty:

HMA APPLICATION FOR CONTRACT TERMINATION REQUEST