To request a copy of your workers' compensation certificate, please complete the form below.

Your first and last name
Your email or fax number
Your phone number
Name of the company insured through the Helpside program
Name of company or party the certificate is to be sent to
Address of company or party the certificate is to be sent to
Person who's attention the certificate should be sent to
Email or fax of company or party the certificate is to be sent to
If the certificate holder requires anything additional on the certificate, such as specific job listed, or specific wording, please list it here.
Click or drag a file to this area to upload.