COORDONNÉES

KATHLEEN GREELEY-HAMILTON

1-800-265-8098 P:221

khamilton@palcanada.com

Mon horaire de travail est du lundi au vendredi de 8h00 à 16h00 heure de l’Est

Vous êtes un courtier ou un agent?

Oui

Non

Section 1

Référence #

44-9878

Is the wedding taking place in Canada?: *

Yes No

Section 2

Select Package: *

Select Liability Limit: *

Liability section offers 3 days of liability coverage within a 7 day period. Events may include rehearsal dinner, ceremony, reception and gift opening. The 7 day period will be effective 3 days prior to the reception date and will end 3 days after.

Section 3

Name of Groom/ Partner 1: *

Name of bride/ Partner 2: *

Address: *

City: *

Province: *

Postal Code: *

Phone Number: *

Click YES to confirm that there are NO known circumstances at this date likely to cause cancellation of the wedding: *

Oui

Section 4

Reception Information

Reception Date: *

Name of Reception Location: *

Reception Address: *

Reception City: *

Reception Province: *

Reception Postal Code: *

Ceremony Information

Ceremony Date: *

Name of Ceremony Location: *

Ceremony Address: *

Ceremony City: *

Ceremony Province: *

Are there any Additional Insured(s) with respect to liability?: *

Yes No

Name of Additional Insured:

#2:

#3:

Section 5

Premium is FULLY EARNED, no return premium on cancellation. Please click yes to confirm that you agree: *

Oui

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 3 full days prior to the reception date. To be eligible for weather related cancellation, the policy must be purchased at least 15 days prior to the wedding date.

Section 6

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: *

Oui

I have reviewed the information above and have ensured it is 100% accurate. I have also included any Additional Insureds that may be required within the Venue’s rental agreement/requirements.

Check to confirm: *

Oui

How did you hear about us?:

If other, please specify:

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Service a la clientèle

Courriel: khamilton@palcanada.com

Numéro de téléphone: 1-800-265-8098 ext 221

Hours: Ontario 8:30am to 4:30pm EST Alberta 8:30am to 4:30pm MST

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