Add Additional Insured

Please use the form below to submit your request for an Additional Insured Certificate. If you need specific verbiage or endorsements, please provide that information in the comments section.

Updated insurance certificates will be issued within 3-5 business days.

Please read: If you are a Martial Arts School or Studio, Vendor, Performer/Entertainer, or Sports Camp, DO NOT use the form below. When you purchased your policy, you received an email with the policy document(s) attached and that contains a link to your policy’s online portal. When you find your policy email, click the link, “Manage My Certificates” and this will take you to your online portal where you can request an additional insured certificate. Certificates are automatically issued using the online portal.

If you can’t find your policy email, please email caitlyn@anthonyinsuranceservices.com and request the link to be sent to you.

Additional Insured request form

Policyholder Information
Policyholder:*

The name as it appears on the policy (i.e the name of the business, organization, event, LARP group, school, etc.)
Contact Name*
First Last
Email*
Phone*
New Additional Insured
Enter the fields below to request an additional insured certificate
Relationship*
Select the relationship of the Additional Insured to the policy
If Other, please explain:
Full Name*
Enter in the name of the Additional Insured as they would like to be listed
Address*
Enter in the address for the Additional Insured as they would like to be listed

Street Address Address Line 2 City State ZIP Code
Certificate Requests and Additional Verbiage (optional)
Enter in the any additional certificate requests such as requesting endorsements or needing specific verbiage listed on the certificate. If specific verbiage is needed, please copy and paste the verbiage into this section
Date you need certificate returned by:
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

Add Additional Insured

Policyholder Information

New Additional Insured

Anthony Insurance Services