Certificate of insurance request template

Send a broker the policy, holder, project and wording details needed to review a certificate request.

Financial template · 9 fields (7 required) · ~2 min for respondents to complete · Free plan · No credit card · Fully customizable

Set up your certificate of insurance request

Send a broker the policy, holder, project and wording details needed to review a certificate request.

Collect certificate instructions for the broker to review. Submission does not issue a certificate, add an insured or change coverage.

The form separates client or business, policy reference, certificate holder name, certificate holder address into labeled questions. Review the choices and required fields for your organization before sharing it.

Best practices

• Collect certificate instructions for the broker to review. Submission does not issue a certificate, add an insured or change coverage.
• Customize the client or business and policy reference questions to match your records and terminology.
• Name the team that reviews responses and explain what happens after submission. A requested date, service or approval is not automatically confirmed.
• Ask only for information needed for this step. Arrange any sensitive supporting documents through an appropriate private process.

Every field, explained

• Your full name (Name, required)
• Email address (Email, required)
• Client or business (Short text, required)
• Policy reference (Short text, required)
• Certificate holder name (Short text, required)
• Certificate holder address (Short text, required)
• Project or contract reference (Short text, required)
• Needed by (Date)
• Requested wording for broker review (Long text)

Frequently asked questions

What does this certificate of insurance request template collect?

Alongside contact details, it asks for client or business, policy reference, certificate holder name, certificate holder address, project or contract reference, needed by, requested wording for broker review. You can rename questions, change choices and remove fields that your workflow does not need.

How should I use this certificate of insurance request form?

Collect certificate instructions for the broker to review. Submission does not issue a certificate, add an insured or change coverage.

Can I edit this form and print a copy?

Yes. Open an editable draft, adjust the questions, and review the preview before publishing. You can also use the template page’s print option. Publishing requires an account; the draft can be tried first.

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Customize this form — opens an editable draft, no account needed — — or browse all 836 templates.