Certificate of Insurance Request

  • KBF Partner

    The top part of this form is where you identify yourself—the KBF Affiliated Club that is submitting this request.
  • MM slash DD slash YYYY
  • Name of KBF AmBASSador submitting this request for COI

  • Additional Insured

    The following information will be used to identify the Entity (e.g., organization, agency, department, municipality) that requires it be identified as "Additional Insured" on KBF's Certificate of Insurance.
  • What is the name of the Entity that's requiring you to provide them with a COI and that should be entered on the form as "Additional Insured"?
  • If the insurance company mails something to the Entity, how should the envelope be addressed?
  • Who is the person the insurance company will deal with in case of a claim against the Entity?
  • What is the name of the tournament/event that you hope to conduct in the area over which the Entity has authority?
  • Where are you planning for the tournament/event to take place?
  • On what date will it take place?
    MM slash DD slash YYYY