Certificate Submission Form

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 Andrea Skyers

by phone at 416-979-5013, or 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.

First Name

Last Name

Title

Email

Primary Phone

Cell Phone

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

Student Insurance Submission

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

For questions about this form, please contact Andrea Skyers

by phone at 416-979-5013, or 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

Attachments

Click "Submit" to finish your submission.

Attachment 1

Attachment 2

Attachment 3

Attachment 4

Attachment 5