HOLE IN ONE INSURANCE APPLICATION

Broker:
Applicant Name:
Applicant Address:
Date of Event:
Name of Tournament: Has this tournament been run previously? Yes No
Name of Golf Course:
Hole Number:	Distance in Yards:
Number of rounds on insured hole:
Number of Participants (Amateurs only):
Hole in One Prize:
Amount of Insurance Required:
Loss Payable:
Quoted Premium:

CONDITIONS

Minimum distance 150 yards Par 3.

One tournament official (19 years of age or older) must be stationed & monitoring play at each of the Insured holes.

Professionals are NOT eligible.

Only one attempt per player will be allowed. A ball hit out of bounds & replayed does not qualify as a “Hole in One”. Mulligans are not eligible for “Hole in One”.

Tournament must be either an 18 or 9 hole tournament. Must be played with groups of 3 to 6. No twosomes are allowed.

Score cards must be completed, signed and attested.

Official stationed near the green at all times monitoring play.

Applications must be received by Angus-Miller Ltd the day prior to the event.

Coverage is only applicable to the first participant making the first “Hole in One” on the selected hole(s)

If any of the above conditions are not complied with, the insurance is null & void.

DECLARATION: I/We the applicant declare that the statements above are in every respect true and correct and I/We hereby apply for a contract of insurance to be based upon the truth of the statements. I/ We have read and understood the conditions above.

Applicants Signature: ________________________________________________ Dated:

Brokers Signature: _____________________________________________

Signing of this application does not bind the applicant or the Insurance Company to complete the insurance, but it is agreed that this form shall be the basis of the contract, should a policy be issued.