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Section 1

Reference #
32-12354


Is This A Block Policy (Seasonal)?: * 
               
A Block Package is a policy with multiple contests added to a schedule throughout the season.

What type of tournament is this?: * 
 
 
 
Location Province: * 
 
Tournament Type: * 
 
Number of Participants: * 
 
Are there any professional golfers?: * 
               
Total Number of Professional Golfers?: 
   
Subject to the terms and conditions of this Hole in One program, there will be a MINIMUM of one witness positioned at the green.: * 
               
Please confirm by checking box that the named insured is NOT an individual. Insured must be a Corporation, Partnership, Association or Bona Fide Club.
Check to confirm: * 
        
How many holes would you like to insure at this tournament?: * 
 

Section 2

Name of insured: * 
   
Address: * 
   
City: * 
   
Province: * 
 
Postal Code: * 
   
Phone Number: * 
   
Email: * 
   

Section 3

Tournament Name: 
   
Date: * 
 
Golf Course Name: * 
   
Course Address: * 
   
City: * 
   
Postal Code: * 
   
Name of Course Pro Manager: * 
   
Hole-In-One - Terms and Conditions
I have read and agree to the above terms and conditions: * 
        

Section 4

Name of person completing this form: * 
   
Mailing Address of person completing form: * 
   
City: * 
   
Province: * 
 
Postal Code: * 
   
Phone Number: * 
   
Email: * 
   
Verify Email: * 
   
Application and full payment must be submitted at least 1 hour (minimum) prior to the tournament/contest start time.

Section 5

I /We hereby declare that the answers and declarations above, whether in my own hand or not, are true and that I /we warrant that no material fact has been withheld or misstated and agree that this proposal will form part of the policy and will form the basis of the contract with underwriters. I /we understand that the underwriters may declare any policy issued void in the event of any false statement, misrepresentation, omission or concealment whether made intentionally, innocently or accidentally. For purposes of the Insurance Companies Act (Canada), this document was issued in the course of Lloyd's Underwriters' insurance business in Canada
I/we agree: * 
        
I have reviewed the information above and have ensured it is 100% accurate.
Check to confirm: * 
        
How did you hear about us?: 
 
If other, please specify: 
   
   

HELPFUL INFORMATION
Here are a few things to try to get your certificate successfully:
  1. Check the screen for any error messages. They will appear in red above the location of the error.
  2. Double check your information to make sure it has been entered correctly.
  3. You can always start over from scratch if you are having issues.
  4. You may want to try a different browser. Sometimes the settings of a certain browser may cause a problem and using a different browser will allow you to complete your submission.

 

CUSTOMER SERVICE
E-mail:  ontario@palcanada.com
Phone: 1-800-265-8098
Hours: Ontario 8:30am to 4:30pm EST Alberta 8:30am to 4:30pm MST

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