Additional Insured Request

If you are part of an inter/national fraternity insurance program, review of event procedures and approval of your headquarters office is required. Holmes Murphy Fraternal Practice will provide information and request approval on your behalf. In all cases, issuance of additional insured protection is at the full discretion of the underwriter. Submission of a request does not automatically grant the requested additional insured protection.

Please note that if this request is in regard to an event, we recommend you complete our Event Planning Guide to plan a safer event.

Fraternity/Sorority Name*
Chapter Name*
Your Name*
Your Title*
Your Email*
Is this for:*
- Special Event
- Term Policy
If for a special event, what is the event? (Tell us if the event will occur over multiple days).*
Date of the Event (If full policy term, use today's date)*
MM slash DD slash YYYY
Venue of the Event
Number of Participants
Additional Insured Information
Name of Additional Insured*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
If required wording is needed, please state:
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Additional Insured Request

Additional Insured Information

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