Sanctuary Plus Certificate of Insurance Form

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

Church Name*

Policy Number (ex. P04XXXX)*

Contact*

Email*

If you would like to include a personal note or any additional information, please do so here:

Frequency of Event*

One Time

Weekly

Date of Event (if for the full policy term please enter the date the certificate should begin)*

How does the Certificate need to be issued?*

Proof of Insurance

Additional Insured Certificate

Please list the full name and address of the organization requesting the certificate*

If the Certificate is for use of a facility, please list the full name and address of the facility

If the Certificate is for an ongoing use, please identify the purpose of the event

Church Services

Sports Nights

Youth Nights

Other

If Other, please give details

If the certificate is for a one time event, please give details of the event and how the church will be participating (i.e. church picnic, inflatables, walkathon)

We collect your personal information to assess your insurance needs and contact you regarding your request.*

I consent to the collection and use of my personal information for this purpose.

Read our Privacy Policy.
We collect your personal information to assess your insurance needs and contact you regarding your request.
Your information will not be shared without your consent except as required to provide insurance services.
Your data is securely stored and only accessible to authorized personnel.
If you do not consent, simply contact our office directly by phone: 1-800-263-9870 to request a certificate of insurance.