The Army Cadet League of Canada

Request for Certificate of Insurance

On occasion, you may be asked by a supporter/agency/corporation to provide proof of liability insurance in order to have access to facilities to conduct approved activities. The Certificate of Insurance will provide such proof and can be obtained by completing this form and submitting it to the appropriate Cadet League National Office.

Requests for Certificates of Insurance should be submitted at least a month (if possible) prior to first date of event for which they are intended.

CORPS INFORMATION

[*] Corps name and number:

[*] Commanding officer’s name:

[*] Phone:

( )
(Area Code) (Phone Number)

Fax:

( )
(Area Code) (Phone Number)

[*] Email:

ACTIVITY INFORMATION

[*] Type of Activity:

[*] Date(s):

From:

Example: January 1, 2008

To:

Example: January 1, 2008

[*] Location of activity:

[*] Address:

[*] Prov.

[*] Postal Code:

example: X1X 1X1 (Uppercase letters only)

CORPORATION/ LANDLORD/ AGENCY INFORMATION

[*] Contact name:

[*] Job Title:

[*] Phone:

( )
(Area Code) (Phone Number)

Fax:

( )
(Area Code) (Phone Number)

[*] Email:

[*] Address:

[*] Prov.

[*] Postal Code:

example: X1X 1X1 (Uppercase letters only)

ADDITIONAL CERTIFICATE INFORMATION (Optional)

Name(s) to be added as additional insured:

1
2
3
4
5

$ Limit required:

REQUEST INFORMATION

[*] Made by:

[*] Date:

Example: January 1, 2008

[*] Phone:

( )
(Area Code) (Phone Number)

Fax:

( )
(Area Code) (Phone Number)

[*] Email:

Comments:

[*] Denotes that the field is required