Condominium Certificate Request Form

Must Have FULL name of Condominium Complex

OR Current Policy #

Name of Purchaser (New Buy) or Owner (Refi/Equity) ✶

Property address & unit # if necessary ✶

City, State, & Zip code ✶

Mortgage Clause: (NOT broker information) WE STILL NEED THIS EVEN IF THERE ARE NO CHANGES BUT YOU WANT IT ON THE CERTIFICATE - IF THIS IS NOT INCLUDED THE CERTIFICATE WILL BE ISSUED lN THE UNIT OWNER'S NAME ONLY - Include Loan Number if Available ✶

Certificates will include property and/or liability coverage, deductibles, employee dishonesty (Fidelity/Crime), replacement cost coverage & total number of units if applicable. Please indicate any additional information needed

Is this an FHA Loan?

Yes

This is a

Closing Date (If available)

Today’s Date ✶

Name of the person to receive certificate ✶

Email Address ✶

Fax Number

Phone Number ✶

McCredie Insurance

Certificate of Insurance

Condo Information