Certificate of Insurance/Coverage Application
Example: 01/01/2013 - 01/05/2013

Enter Name of Organization Here.

What organization is this being issued to?

Where can the Certificate of Coverage be mailed to?

Where can the certificate of coverage be emailed to?

Where can you be reached at, if we have questions?

Why do you need the certificate of coverage?


University of Wisconsin-River Falls
410 S. 3rd Street, River Falls WI 54022 USA
Campus Information 715-425-3911