Event_Special Request for Certificate Form
Submission is required 14 days prior to event. Email to kelsey@norwichinsurance.com or Fax: 519.863.2015.
EVENT DETAILS
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WHO IS THE CERTIFICATE HOLDER? (Who has asked Rotary/Rotaract Club for Proof of Insurance?)
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IS THERE ANYONE WHO HAS ASKED TO BE SHOWN AS AN ADDITIONAL INSURED FOR THIS EVENT?
IS THERE ANYONE WHO HAS ASKED TO BE SHOWN AS AN ADDITIONAL INSURED FOR THIS EVENT?
Should be Empty: