Get Certificate Of Insurance Request Form: Insureds Name: Date: Cert

Filling out the Certificate Of Insurance Request Form is essential for individuals or organizations seeking to obtain proof of insurance coverage. This guide provides a clear, step-by-step approach to completing the form correctly, ensuring that all necessary information is accurately provided.

Follow the steps to complete the form efficiently.

1. Click the ‘Get Form’ button to access the Certificate Of Insurance Request Form and open it in your preferred editing tool.
2. Begin by filling out the 'Insureds Name' field with the full name of the individual or organization requesting the certificate.
3. In the 'Date' field, enter the date on which you are completing the request form.
4. Fill in the 'Certificate Holder Name & Address' section. This should include the name of the person or organization requesting the certificate, followed by their complete address.
5. Indicate whether the certificate holder is an additional insured by checking 'Yes' or 'No'.
6. Provide the 'Certificate Holder Fax #' and 'Certificate Holder email' for future correspondence regarding the request.
7. Select the coverages needed by marking the appropriate boxes. Options include Workers Comp, General Liability, Umbrella, Equipment Floater, Auto, or Other specialty coverage. If other, specify the coverage needed.
8. In the 'Description wording to be included' section, provide any specific wording or details that should be included on the certificate.
9. If applicable, include the details for 'Additional Insured' by writing the relevant information in the provided space.
10. Indicate if the additional insured should be on a Primary & Non-Contributory basis; provide details if necessary.
11. Specify if a Waiver of Subrogation is required by checking 'Yes' or 'No'. If 'Yes', complete the required job information.
12. Complete the 'Job Information' details, including the interest of the holder, dates of the job (start and end), cost of the job, location, and description of the job.
13. Review all entered information for accuracy before finalizing the form.
14. Once completed, save changes to the form, and choose to download, print, or share it as needed.

Complete your Certificate Of Insurance Request Form online today to ensure all necessary coverage is secured.