Certificate Submission Form

Are you a student submitting proof of insurance?

Certificate of Insurance

Attach a physical copy of the certificate using the "Attachments" feature below.

NOTE: If your Insured Contact does not exist on the list you must select "Yes" under Add New Contact and submit the New Contact details below.

For questions about this form, please contact Niall McGarrigle

by email at insurance@torontomu.ca

Insured Contact	Add New Contact? "YES" - My Insured Contact did not appear on the list and I need to add their information. "NO" - I found the correct Insured Contact information on the list to the left.

New Contact Details

Please fill the following fields and submit to generate a new insured contact for your organization.

Insurance Certificate Name

Enter the name located at the top of your certificate

Certificate Expiry Date

Date that the insurance policy expires.
Select from calendar or use format: MM/DD/YYYY

Is this certificate related to a project?

Project Name

Project Expiry Date

Select from calendar or use format: MM/DD/YYYY

Your Name

Your Email Address

Attach a physical copy of the certificate using the "Attachments" feature below.

For questions about this form, please contact Niall McGarrigle

by email at insurance@torontomu.ca

Building Name	Certificate Expiry Date Date that the insurance policy expires. Select from calendar or use format: MM/DD/YYYY
First Name	Last Name
Student Number Your Toronto Metropolitan University Student Number	Primary Email
Primary Phone	Cell Phone
Covered under parents/supporter/guardian policy?	Parents Policy Number Canadian Policy Number

Student Certificate Name

Click "Submit" to finish your submission.

Attachment 1

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Attachment 5