Wilkes University

Certificate of Insurance Form

Certificate of Insurance Request Form

Certificate of Insurance Request Form

Certificate of Insurance Request Form

Complete this form to request a Wilkes University Certificate of Liability (COI) insurance be generated for a third party individual or company. (COI’s will be returned to you within 1-3 business days.)

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    • Today's Date


Wilkes Contact Information

Name*

    • Phone Number*
    • - -


Insurance Required


Certificate Holder Information

    • Contact Name*
    • Mailing Address*


Additional Insured


Agreement/Lease/Event Date

    • Start Date
    • End Date


Reason For Certificate

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