<p style="text-align:center"><img alt="" class="aligncenter" src="http://www.propertycasualty360.com/coveragespecialist/wp-content/uploads/2025/05/TouchpointMarkets-Logo-Horiz-RGB-Color-1-1.png" style="height:72px; width:393px" /></p> <p style="text-align:center"><strong><span style="font-size:large">Cannabis Insurance Claims Specialist Program</span></strong></p> <p style="text-align:center"><strong><span style="font-size:large">Request for Certificate Form</span></strong></p> <p style="text-align:center"><span style="font-size:medium">Congratulations! You have passed all of the required Online Exams for the CICS Designation Program!</span></p> <p style="text-align:center"><span style="font-size:medium">Your Request for Certificate has been automatically sent to the CE Department </span></p> <p style="text-align:center"><span style="font-size:medium">(<a href="mailto:designations@alm.com">designations@alm.com</a>) and your certificate will be mailed within 2 weeks to the address indicated below.</span></p> <table border="0" cellpadding="0" cellspacing="0" style="width:100%"> <tbody> <tr> <td><span style="font-size:medium"><strong>Name: </strong></span>%username%</td> <td><span style="font-size:medium"><strong>Address:</strong></span> %street%</td> </tr> <tr> <td> </td> <td> </td> </tr> <tr> <td><span style="font-size:medium"><strong>Email:</strong></span> %useremail%</td> <td> </td> </tr> </tbody> </table> <p><span style="font-size:medium"><strong><input name="acceptance" required="required" type="checkbox" value="accepted" /> I affirm that I personally completed the entire text of the course. I affirm that I personally completed the examinations without assistance from any outside source.</strong></span>   *#Please do not edit the table below</p> <table border="0" cellpadding="0" cellspacing="0" class="scoreclass" style="width:100%"> <thead> <tr> <th scope="col" style="width:33%"><span style="font-size:medium"><strong>Course</strong></span></th> <th scope="col" style="width:33%"><span style="font-size:medium"><strong>Score</strong></span></th> <th scope="col" style="width:33%"><span style="font-size:medium"><strong>Completed date</strong></span></th> </tr> </thead> <tbody> <tr> <td><span style="font-size:medium">exam name</span></td> <td>score</td> <td>date</td> </tr> <tr> <td><span style="font-size:medium">exam name</span></td> <td>score</td> <td>date</td> </tr> <tr> <td><span style="font-size:medium">exam name</span></td> <td>score</td> <td>date</td> </tr> </tbody> </table> <p>Please do not edit the table above#*</p>