Broker / Agent Login


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Contact Information

Jennifer Stackhouse

1-800-265-8098 ext: 242

jstackhouse@palcanada.com

My regular office hours are Monday- Friday, 8:30 am to 4:30 pm Eastern Time



Are you a Broker or Agent?   







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Section 1

Reference #
32-933


Location Province: * 
 
Number of Participants: * 
 
How many holes would you like to insure at this tournament?: * 
 

Section 2

If you wish to bind coverage, please complete the application below:
Please note that this web application is for amateur golfers only, please confirm that only amateur golfers will participate.
Check to confirm: * 
        
Name of insured: * 
   
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: * 
        
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: * 
   
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. I have also included any Additional Insureds that may be required within the Venue’s rental agreement/requirements.
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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