Policy Change Request

This e-mail request is intended to allow Gallagher Charitable International Insurance Services (Gallagher Charitable International Insurance Services) to begin processing your change. Please note that changes to insurance coverage can not be effective until a written acknowledgement is issued from Gallagher Charitable International Insurance Services. It may be necessary to obtain additional information to complete the processing of your change. Please complete as many of the fields as you can to expedite your change request.

 

First Name
Last Name
Your Address
Address 2
City
State Zip:
Mission Organization
Policy Number
(if known)
Country of Origin
(if applicable)
Email Address
Phone
Fax
Original Policy Effective Date:
Requested Effective Date of Change:
What Would You Like Us to Change?

Additional or return premium generated by this change, if other than the original payer should be sent to: (please explain)

  You
Your 3rd Party Premium Payer
Other (please list below):
Other?
Comments

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Please note that insurance coverage for any line or class of business can not be effective until a written acknowledgment is issued by the Insurance Company. This site is presented as a brief overview of our programs and services. For coverage specifics, please refer to the actual policy.

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