Cancellation form

Please fill in the form to cancel your subscription for the following products: Mobile, Internet , Landline , Television.

Note: in case of a decease of a person in your immediate environment, you can also take over a part or all of the Proximus services of the deceased for free.

Your personal data

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{{errorMessages.name.required}} {{errorMessages.name.pattern}} {{errorMessages.name.pattern}} {{errorMessages.name.pattern}} {{errorMessages.name}} {{errorMessages.name.pattern}}
{{errorMessages.firstname.required}} {{errorMessages.firstname.pattern}} {{errorMessages.firstname.pattern}} {{errorMessages.firstname.pattern}} {{errorMessages.firstname}} {{errorMessages.firstname.pattern}}
{{errorMessages.street.required}} {{errorMessages.street.pattern}} {{errorMessages.street.pattern}} {{errorMessages.street.pattern}} {{errorMessages.street}} {{errorMessages.street.pattern}}
{{errorMessages.number.required}} {{errorMessages.number.pattern}} {{errorMessages.number.pattern}} {{errorMessages.number.pattern}} {{errorMessages.number}} {{errorMessages.number.pattern}}
{{errorMessages.box.required}} {{errorMessages.box.pattern}} {{errorMessages.box.pattern}} {{errorMessages.box.pattern}} {{errorMessages.box}} {{errorMessages.box.pattern}}
{{errorMessages.zip.required}} {{errorMessages.zip.pattern}} {{errorMessages.zip.pattern}} {{errorMessages.zip.pattern}} {{errorMessages.zip}} {{errorMessages.zip.pattern}}
{{errorMessages.city.required}} {{errorMessages.city.pattern}} {{errorMessages.city.pattern}} {{errorMessages.city.pattern}} {{errorMessages.city}} {{errorMessages.city.pattern}}
{{errorMessages.email.required}} {{errorMessages.email.pattern}} {{errorMessages.email.pattern}} {{errorMessages.email.pattern}} {{errorMessages.email}} {{errorMessages.email.pattern}}
{{errorMessages.CALLBACKCLICountry.required}} {{errorMessages.CALLBACKCLICountry}}
{{errorMessages.CALLBACKCLIPhone.required}} {{errorMessages.CALLBACKCLIPhone.pattern}} {{errorMessages.CALLBACKCLIPhone.pattern}} {{errorMessages.CALLBACKCLIPhone.pattern}} {{errorMessages.CALLBACKCLIPhone}} {{errorMessages.CALLBACKCLIPhone.pattern}}
{{errorMessages.CusI.required}} {{errorMessages.CusI.pattern}} {{errorMessages.CusI.pattern}} {{errorMessages.CusI.pattern}} {{errorMessages.CusI}} {{errorMessages.CusI.pattern}}
Main reason (optional) (optional)
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{{errorMessages.reason.required}} {{errorMessages.reason.pattern}}
{{errorMessages.reason.required}} {{errorMessages.reason.pattern}}
{{errorMessages.reason.required}} {{errorMessages.reason.pattern}}

Please specify which products to cancel

{{errorMessages.internet_cancel.required}} {{errorMessages.internet_cancel.pattern}}
{{errorMessages.internet1.required}} {{errorMessages.internet1.pattern}} {{errorMessages.internet1.pattern}} {{errorMessages.internet1.pattern}} {{errorMessages.internet1}} {{errorMessages.internet1.pattern}}
{{errorMessages.internet2.required}} {{errorMessages.internet2.pattern}} {{errorMessages.internet2.pattern}} {{errorMessages.internet2.pattern}} {{errorMessages.internet2}} {{errorMessages.internet2.pattern}}
{{errorMessages.internet3.required}} {{errorMessages.internet3.pattern}} {{errorMessages.internet3.pattern}} {{errorMessages.internet3.pattern}} {{errorMessages.internet3}} {{errorMessages.internet3.pattern}}
{{errorMessages.tv_cancel.required}} {{errorMessages.tv_cancel.pattern}}
{{errorMessages.tv.required}} {{errorMessages.tv.pattern}} {{errorMessages.tv.pattern}} {{errorMessages.tv.pattern}} {{errorMessages.tv}} {{errorMessages.tv.pattern}}

Keep your devices, you will receive more information in the confirmation letter you’ll find in your letterbox very soon.

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{{errorMessages.gsm1.required}} {{errorMessages.gsm1.pattern}} {{errorMessages.gsm1.pattern}} {{errorMessages.gsm1.pattern}} {{errorMessages.gsm1}} {{errorMessages.gsm1.pattern}}
{{errorMessages.gsm2.required}} {{errorMessages.gsm2.pattern}} {{errorMessages.gsm2.pattern}} {{errorMessages.gsm2.pattern}} {{errorMessages.gsm2}} {{errorMessages.gsm2.pattern}}
{{errorMessages.gsm3.required}} {{errorMessages.gsm3.pattern}} {{errorMessages.gsm3.pattern}} {{errorMessages.gsm3.pattern}} {{errorMessages.gsm3}} {{errorMessages.gsm3.pattern}}
{{errorMessages.fix_cancel.required}} {{errorMessages.fix_cancel.pattern}}
{{errorMessages.fix1.required}} {{errorMessages.fix1.pattern}} {{errorMessages.fix1.pattern}} {{errorMessages.fix1.pattern}} {{errorMessages.fix1}} {{errorMessages.fix1.pattern}}
{{errorMessages.fix2.required}} {{errorMessages.fix2.pattern}} {{errorMessages.fix2.pattern}} {{errorMessages.fix2.pattern}} {{errorMessages.fix2}} {{errorMessages.fix2.pattern}}
{{errorMessages.fix3.required}} {{errorMessages.fix3.pattern}} {{errorMessages.fix3.pattern}} {{errorMessages.fix3.pattern}} {{errorMessages.fix3}} {{errorMessages.fix3.pattern}}
{{errorMessages.remark.required}} {{errorMessages.remark.pattern}} {{errorMessages.remark.pattern}} {{errorMessages.remark.pattern}} {{errorMessages.remark}} {{errorMessages.remark.pattern}}
{{errorMessages.date_cancel.required}} {{errorMessages.date_cancel.pattern}} {{errorMessages.date_cancel.pattern}} {{errorMessages.date_cancel.pattern}} {{errorMessages.date_cancel}} {{errorMessages.date_cancel.pattern}}

Proximus will execute your request within maximum 1 week.

Please wait, your data is being processed

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