Application for Hole-in-One Insurance Please provide the following information: Contact (Broker) Name: Contact Address: Street Address City, State, Country Postal Code Insured Name: Insured Address: Street Address City, State, Country Postal Code 2. Please provide the following information pertaining to the golf course on the event will take place: Course Name: Course Address: Street Address City, State, Country Postal Code 3. Event Name: 4. Event Date(s): Value: Currency 5. Prize details: Description: Insured Hole: 6. Please provide the number of event participants: Number of Number Participants Number Amateur Yardage attempts Professional Male Female
Application for Hole-in-One Insurance Please provide the following information: Contact (Broker) Name: Contact Address: Street Address City, State, Country Postal Code Insured Name: Insured Address: Street Address City, State, Country Postal Code 2. Please provide the following information pertaining to the golf course on the event will take place: Course Name: Course Address: Street Address City, State, Country Postal Code 3. Event Name: 4. Event Date(s): 5. Prize details: Value: Currency Description: Insured Hole: 6. Please provide the number of event participants: Participants Number Amateur Number Professional Yardage Number of attempts Male Female
TCIM-HIO-Ins2.docx