Certificate of Insurance Request Form

Contractors and tenants request a certificate naming a third party, with all the underwriting detail an agent needs. Job location, scope of work, occupancy, and additional insured questions are covered in a single pass. Built for brokers who want to avoid long email chains.

Use this template

In the Claude connectors directory

Policy holder's name

First Name

Last Name

Trading or business name

Your policy number

Requested by

First Name

Last Name

Your email address

Phone number

Name of certificate holder

First Name

Last Name

Address of certificate holder

Street Address

City

State / Province

ZIP / Postal Code

Certificate holder email

Should the certificate holder be named as an additional insured?

Additional insured names

Is there a contractual obligation to name the additional insured above?

If not, explain why it is needed

Who occupies or will occupy the project

Detailed job description

What are the operations of the requested additional insured?

Is the additional insured involved in new construction of condominiums, tract housing, subdivisions, townhouses, or apartment buildings?

Does the additional insured carry their own insurance for their own exposures?

Job or project location

Street Address

City

State / Province

ZIP / Postal Code

Intended occupancy of the project (for example: store, dwelling, hospital)

Project type

Job type

If this is new residential construction, what type is it?

Is the job related to a construction defect claim?

Comments

File upload

Max 10 MB per file

Related templates

Browse all requests templates →