Formal request for a Certificate of Insurance (ACORD 25 or equivalent) from an insurer or agent, specifying the required coverage types, limits, additional insureds, and certificate holder details.
The Certificate of Insurance (COI) Request is a ready-to-use insurance & risk template you can send for signature in minutes. It is written for 1 signer (policyholder) and, by default, expires 14 days after it is sent if left unsigned. It covers certificate of insurance, coi, acord 25, insurance request, additional insured. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
Document Preview
# Certificate of Insurance (COI) Request **Request Date:** ___________ **Requested By (Company / Individual):** ___________ **Requesting Party Address:** ___________ **Requesting Party Contact Name:** ___________ **Requesting Party Email:** ___________ --- ## 1. Policyholder Information **Named Insured (as it appears on the policy):** ___________ **Named Insured Mailing Address:** ___________ **Named Insured Contact Name:** ___________ **Named Insured Contact Email:** ___________ **Named Insured Contact Phone:** ___________ --- ## 2. Insurer / Agent Information **Insurance Agency or Brokerage:** ___________ **Agency Address:** ___________ **Agent / Broker Name:** ___________ **Agent / Broker Email:** ___________ **Agent / Broker Phone:** ___________