Certificate of Insurance Request

Certificate of insurance request page available at Texas Partners Insurance Group

Client Information

*Policy Number

*First Name:

Middle Initial:

*Last Name:

*Email:

*Name of Company:

*Address:

*City:

*State:

*ZIP:

*Phone:

Certificate Holder Information

*Full Business Name

*Address:

*City:

*State:

*ZIP:

*Fax Number:

*Does this certificate holder require Additional Insured Status?

**Does this certificate holder require Primary Status?

*Does this certificate holder require a Waiver of Subrogation?

Disclaimer:

Texas Partners Insurance Group & Financial Services, LLC will make every possible effort to issue your certificate of insurance request within one business day of the request but due to certain Insurance Company regulations we cannot guarantee this timeline.

Additional Insured Status, Primary Status, Non-Contributory Status, and Waiver of Subrogation may not be available to all client's due to the coverage's provided in the client's insurance policy.

Additional Insured Status, Primary Status, Non-Contributory Status, and Waiver of Subrogation requests may generate substantial premium charges to the client's policy. By submitting this request you are acknowledging that premium charges may be associated with this request and that you will be invoiced by Texas Partners Insurance Group & Financial Services, LLC for these charges. Submitting this request also acknowledges an agreement to pay these charges as invoiced. Failure to pay these charges within the invoiced timeline will result in non-payment cancellation of your insurance policy.

Comments

Comments are closed.