Certificate of Insurance Request

Complete this form to request a Certificate of Insurance

Treasury - Request for Certificate of Insurance

Certificate Request Information

Chapter

Coordinator

Volunteer requesting certificate

Name of Event

Event Location

City

State/Province

Event Location

Add the Date or Dates of the Event

List Date (s)

Add Remove

Organization Requesting Certificate

Organization Requesting Certificate (Not MAGDRL)

Address

City

State/Province

Zip/Postal

Country

Proof only or Additional Insured

Proof Only

Additional Insured

NOTE:

If the certificate holder is requesting to be named as additional insured, we will need a copy of the vendor agreement or signed contract for the event.

File Upload

Maximum file size: 516MB

If requesting to be named as additional insured enter the wording they want used on the certificate

0 of 500 max characters

If you are human, leave this field blank.

Complete this form to request a Certificate of Insurance

Certificate Request Information

Add the Date or Dates of the Event

Organization Requesting Certificate

MAGDRL

Chapter Websites

Chapter Events

Useful Links