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CALIFORNIA STATE UNIVERSITY SACRAMENTO Risk Management Services SAFELY/SPLIT Certificate of Insurance Request Form Name of requester: Date: Department: Phone #: Do you need a copy of the certificate?
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Start by writing your full name in the specified format (e.g., First Name, Middle Initial, Last Name)
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Next, enter the current date in the requested format (e.g., DD/MM/YYYY)
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Once completed, submit the form or document as instructed

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Various individuals or entities may require the name of the requester and the date, including:
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These are just a few examples, but the need for the requester's name and date can arise in numerous situations.
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The name of requester date is the name of the individual or entity requesting certain information or services.
Any individual or entity who is requesting specific information or services may be required to file a name of requester date.
The name of requester date should be filled out with the requester's name and any other relevant information.
The purpose of the name of requester date is to identify the individual or entity making the request.
The name of the requester and any other relevant information related to the request must be reported on the name of requester date.
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