Request Proof of Coverage
* denotes required field
Name of Requesting Party*
Company*
Phone
Fax
Email
Insured's Name
Which policy type
are you verifying?
Auto
General Liability
Property
Workers Compensation
Umbrella
Other
Additional Insurance/Morgagee Wording
Yes
No
If the above was answered yes, how should company read on dec page? What interest should be shown? Please include name, address and account/loan number.
Please note any additional information needed for our office to issue proof of coverage
Please be advised that it is our policy to confirm all requests with our insureds prior to releasing any policy information to a third party. Once your request has been approved, the above information will be forwarded. Should you need further assistance, please contact Gallen Insurane at 610.777.4123 and ask for Commercial Lines Account Services.
