Queen's University Secure Forms Service

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Request Certificate of Insurance Form

For information regarding why external organizations may request a Certificate of Insurance or “Proof of Insurance”, please read the Proof of Insurance page on the insurance and risk management website.

Queen's Contact Information
Contact Information of Certificate holder

*note: the "Certificate Holder" is the external organization requesting the certificate and not the individual from Queen’s in which the insurance covers.

Type of Insurance Required
$
$
$
$
Nature of the operations for this certificate