Please use this form when requesting insurance certificates from the CBTF insurance broker.

To use the online form:

• Type your information into the appropriate box and click the Submit button.
• Fields marked with the * are mandatory and must be provided.
• The request will be sent directly to Peter Yeh by email.
• A copy of the request will be sent to the email address entered in 'Email' field on the form.

The information entered below will be sent directly to Peter Yeh and a certificate will be issued.

Contact Information

From: *

Name of person requesting Insurance Certificate

Mailing Address: *

Mailing address to receive paper certificate. Enter full address including City, Province and Postal Code.

Email: *

Email address of person requesting Insurance Certificate. Used if any clarifications are required.

Fax:

Optional. Fax number to receive copy of insurance certificate. Remember to include your Area Code.

Request Details

Club Name:

Optional. Club name that should appear on the certificate.

Sanction #: *

Sanction Number provided by the Provincial or National Sanction Officer. Without a valid Sanction #, no certificate will be issued.

Type of Event: *

Enter the Type of Event as indicated on your Sanction Request Form

Name and Address of Facility: *

The location of the event. Enter full address including City, Province and Postal Code.

Name and Address of School Board or Landlord: *

Business address of the School Board or facility landlord. Enter full address including City, Province and Postal Code.

Any Special Conditions:

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