Allen Financial Insurance Group

Report An Event
Certificate / Additional Insured 
Endorsement Request

 Event Information

Underwriting Questions

I/We hereby request an insurance for the event(s) or activity shown above.  I/We understand and agree that this request shall form part of any policy issued or in effect and that the Company requires that I/We obtain certificates of insurance from all sub-contracotrs and independent contractors. 

Complete as early as possible prior to date of activity.  I/We agree that, if this application is sent to you by facsimile or other electronic means, you may act upon it whether or not you receive an original hard copy.  Coverage is not provided for events, activities or show dates that have not been declared and approved by the insurance company in writing prior to of the event.

FRAUD WARNING: Any  person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing false information or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act which is a crime.


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