Proof

This page is for banks and other policy stakeholders to create requests for proof of coverage and changes like Mortgagee Clauses, Loss Payee Clauses, and Additional Insureds.

Proof of Coverage

Requesters Name*
Requesters Company Name*
Email Address*
Best Phone Number to Reach You*
Please provide name of the insured / client on the policy you're requesting to change.
I am requesting the following*
(ChecK all that apply)
- Mortgagee Clause
- Loss Payee Clause
- Additional Insured
- Other
What would you like in the Certificate Holder box on the ACORD form?
(Please write it exactly how you'd like it to be shown.)
Location of premises, or other description of property impacted by your change request.
(Be Specific)
Other notes related to your request:
Comments
This field is for validation purposes and should be left unchanged.