Evidence of Coverage Request

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Please use this form to request proof of insurance coverage.

Most requests are completed within 24 business hours.
If you need this sooner, please contact our office at 203-834-5900.

Coverage Type

Evidence of Coverage (General)

Evidence of Commercial Property Coverage

Please Select One:

Request Information

Request Date

Your Full Name

Your Phone Number

Your Email Address

Policy Information

Named Insured (Business or Individual Name on Policy)

Policy Term (If Known)

Loan Number (If Applicable)

Insured Property Address (If Applicable)

Address

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code

Evidence Holder

Holder / Recipient Name

Attention (If Applicable)

Address

Recipient Address Line 1 Recipient Address Line 2 City State / Province / Region ZIP / Postal Code

Delivery Method

How Should We Send the Evidence?

Fax

Additional Requirements

Does the Evidence Holder need to be listed as one of the following?

Loss Payee

Lender’s Loss Payee

Mortgagee

Not Required

Not Sure

Special Instructions

Please include any special wording, requirements, or notes for this request.

Attachments (If Available)

Drop files here or

Max. file size: 5 MB, Max. files: 10.

If you received a request from a lender, landlord, or other party, please attach it here so we can review their exact requirements.
(Examples: Email request, lease agreement, lender request, etc.)

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Evidence of Coverage Request

Request Information

Policy Information

Evidence Holder

Delivery Method

Additional Requirements

Schedule a Review

(203) 834-5900

Affiliations

Connecticut Office

New York Office