Complete the information below:

Insured Name

First Name

Last Name

Insured Email Address

Insured Policy Number

Certificate Holder Name

First Name

Last Name

Company

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Need to add an additional insured? Visit Alliant Connect and log-in to your client portal.

Having trouble or other requests? Email us at yoga-questions@alliant.com or call 855-827-YOGA