Dentist's Advantage Proof of Coverage Request

Toll-Free 1-888-778-3981

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You can use this simple and secure process to request proof of either your liability coverage or your property coverage. This service is provided by Dentist's Advantage free of charge!

Some examples of why you might need to show a certificate of insurance are:

To a landlord who wants you to secure your own business liability coverage
To a PPO or HMO who needs to confirm that you carry your own professional liability insurance.
To a leasing company to show that you have insurance that covers the contents, including leased equipment, of your office from damage.
To a financing company to show that the property you've used to secure a loan is insured against loss.

Or, you may also simply need a copy of your proof of coverage for your own records.

If you would like further information about certificates of insurance, please call our client service center at 1-888-778-3981.

Your Information

Concerned about security?

*Required field
*Name:
*Policy #:
Address 1:
Address 2:
City:
State:
Zip:
Phone:	- -
Fax:	- -
Email:
*Proof of coverage needed:	Liability Insurance Property Coverage
*Party receiving proof of coverage:	Self Lienholder Mortgagee Other Additional Insured PPO/HMO Other

If third party is receiving certificate of insurance, indicate contact information below:

Name:
Address 1:
Address 2:
City:
State:
Zip:
Fax:	- -

Answer the following if applicable:

Location of building or equipment (if for property coverage):
Loan or Lease # (if proof is for leinholder or mortgagee):
If loan or lease, is additional property coverage required?:	Yes No
If yes, how much?

Delivery Options:

Indicate any special wording required:
*Send my certificate by:	Mail Fax

Dentist's Advantage is a division of Affinity Insurance Services, Inc.