Allsafe Insurance Group, Inc.
7171 Coral Way, Suite 209
Miami, FL 33155
Office: 305-262-5244
Fax: 786-388-7244

Office Days: Monday - Friday
Hours: 9am - 5pm

REQUEST FOR A PROOF OF INSURANCE

(PLEASE ATTACH COPY OF LETTER FROM MORTGAGEE/CERTIFICATEHOLDER)
By providing the information below you will help ensure accuracy and a prompt response.

   
NAME OF INSURED:
PERSON REQUESTING:
BEST PHONE NUMBER TO CONTACT YOU:
ASSOCIATION / PROJECT NAME:
CERTIFICATEHOLDER/MORTGAGEE NAME/ADDRESS/PHONE/FAX:
ACCOUNT / LOAN:
FAX:
EMAIL:
POLICY NUMBER:
CHECK ALL THAT APPLY: (ENDORSEMENT FEES MAY BE REQUIRED)
MORTGAGEE     ADDITIONAL INSURED     WAIVER OF SUBROGATION