Certificate of Insurance Online Request Form

Please complete this form if you require a Certificate of Insurance.

Please note that the Certificate will be forwarded to the U of A contact as stated below.

Use tab or mouse (not enter) to advance to the next field.

Important:  Please note that the Certificate Holder is the organization requesting the Certificate.  It cannot be the University of Alberta.

University of Alberta Contact Information
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Contact Information of Certificate Holder
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Nature of the Operations for this Certificate
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This Certificate is For

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Is the requesting party asking to appear as an additional insured?

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Type of Insurance Required
General Liability

Automotive Liability

Notes