GSMW Certificate of Insurance (COI) Request Form
Troops, Service Units, and GSMW staff sometimes require a copy of GSMW’s Certificate of Insurance. COI’s are specific to the person/organization requesting the Certificate. To fulfill your request, please fill out the following Certificate of Insurance Request Form.
Type of Request
*
Standard evidence of insurance
Need to be named as additionally insured
Membership Year (Oct 1-Sept 30)
*
Current Year
Next Year
Both Years
Person Completing Form
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Troop Number / SU Number
If applicable
Troop Role / SU Role
If applicable
Requesting Entity Details
Requesting Entity
*
Delivery Preference
*
Email
Mail
Fax
Requesting Entity Email
*
example@example.com
Requesting Entity Address (meeting / event location)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Fax Number
-
Area Code
Phone Number
Submit
Should be Empty: