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Insurance Certificate Request
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Insurance Certificate Request
Insurance Certificate Request
clerette
2025-10-06T13:48:35-03:00
INSURANCE CERTIFICATE REQUEST (#27)
INSURANCE CERTIFICATE REQUEST
CLIENT/INSURED: Soccer Nova Scotia (or member club)
Requester First Name
Requester Last Name
Requester Email
Affiliated Club, District or League
INSURER: Markel Canada Limited
Is this an annual certificate
- Select -
Yes
No
From Date
To Date
Operations other then those declared on the policy
- Select -
Yes
No
Location of Work
Additional Insured
Additional Insured Address
Relationship to Client
Special Requests
PLease attach any written agreement between yourselves and the Additional Insured pertaining to the insurance requirement
Choose File
Submit Form
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