Endorsed by the Golf Union Of Wales. Sports and Leisure Caddysure Individual Golfers Proposal Form.

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1 Endorsed by the Golf Union Of Wales Sports and Leisure Caddysure Individual Golfers Proposal Form

2 Golf is now more popular than ever and with increasing numbers of people playing, there can be more to worry about than just your back swing. Equipment is expensive to replace if it s lost, damaged or stolen and with a sharp rise in the number of people on the course you need to take extra care in case of accidents, either to you or caused by you! The best golfers rely on their caddy to ensure they have a good game. Now you can insure yourself a trouble free round with our caddy CADDYSURE. CADDYSURE is an insurance package tailored to meet the needs of the individual golfer. Cover costs from as little as per year and is available to all amateur golfers resident in the UK. CADDYSURE will pay for the repair or replacement of lost or damaged golf equipment. It also provides Personal Accident benefits, cover against accidental injury to third parties or damage to their property and includes our unique Hole-in- One Cover. Golf Equipment is covered continuously throughout the period of insurance, whilst anywhere within the UK, for up to 1,500. This can be increased by purchasing one of the OPTIONAL EXTENSIONS. We can then provide cover anywhere in the World excluding USA and Canada for any Trip up to 30 days duration. Cover for equipment is automatically increased to A further extension can be purchased to provide cover for the USA and Canada. Personal Effects, Personal Accident and Public Liability covers apply whilst at any golf club, course or driving range in the UK, and there is even cover against theft of Pedestrian Battery Assisted trolleys from a securely locked building, anywhere in the UK. Hole-in-One cover applies whilst you are competing in any official Affiliated Golf Club Competition or Tournament or any PGA Pro Am Competition or Tournament within the UK and in respect of private Golf Club Members, at all times whilst at any Golf Club within the UK. 2

3 CADDYSURE Putting Golfers First Insurance cover available to all amateur golfers resident in the UK Cover for loss of or damage to golf clubs and equipment up to 1,500 Option to increase golf clubs and equipment cover to 2,000 including worldwide cover (but excluding USA and Canada) Option to extend worldwide cover to Include USA and Canada Public Liability cover up to 5,000,000 covering legal liability for damages and costs following damage to third party property or injury to a third party on the golf course Personal Accident protection up to 50,000 Personal Effects cover up to 500 Hole in One celebration cover 100 A specimen copy of the policy is available on request. 3

4 Instruction to your Bank or Building Society to Pay by Direct Debit Please fill in the form and return it with your Application Form to: CCV Underwriting Sports & Leisure, Towergate House, St Edward s Court, London Road, Romford, Essex RM7 9QD. Name and full postal address of your Bank or Building Society Originator s Identification Number Reference: The Manager Bank/Building Society Address Instruction to your Bank or Building Society Please pay CCV Underwriting Sports & Leisure, from the account detailed on this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with CCV Underwriting Sports & Leisure, and if so, details will be passed electronically to my Bank/Building Society. Postcode # Name(s) of Account Holder(s) Bank/Building Society Account Number Signature(s) Branch Sort Code Date Bank and Building Societies may not accept Direct Debit Instructions for some types of account

5 Declaration To apply for this Insurance, simply read the Declaration below and provided you can agree without reservation to the statements made, complete and sign the attached Direct Debit Instruction overleaf and return it to:- CCV Underwriting Sports & Leisure. Declaration By completing and signing the Direct Debit Instruction 1) I confirm that to the best of my knowledge and belief:- a) during the past 3 years (whether insured or otherwise) I have not sustained any injury or loss of or damage to property or incurred any liability that could have resulted in a claim under a policy of this nature had it been in force at the time. b) I have never had a proposal for insurance refused had insurance terminated, renewal refused or special terms or conditions imposed. c) I have never been cautioned or convicted (or charged with but not yet tried) of arson or with any offence involving dishonesty e.g. fraud, theft or handling stolen goods (This confirmation need only be made in accordance with the provisions of the Rehabilitation of Offenders Act 1974). 2) I have had the opportunity to familiarise myself with the terms, exclusions, conditions and limitations of this policy and understand that should I attain the age of 75 years during the Period of Insurance the cover provided under Section 2. Personal Accident will automatically cease. 3) You are free to choose the law applicable to this policy. Your policy will be governed by the law of England and Wales or if you normally reside in Scotland, Northern Ireland, The Channel Islands or the Isle of Man then the Law applicable to that appropriate Country will apply unless You and We have agreed otherwise. 4) I consent to the information on this form and on any claim form I may make, being available to other insurers and I also agree that, in response to any searches the company make in connection with this application or any claim, the company may supply information it has received from other insurers about other claims I have made. 5) I declare that to the best of my/our knowledge and belief the information supplied in this proposal is true and that I have not withheld any MATERIAL FACTS (if you are in any doubt as to whether a fact is material you should, for your own protection, disclose it) I/we understand that any misrepresentation may render any policy void. If having read this declaration you are unable to agree with the statements made, you may still be eligible for this insurance. Please contact CCV Underwriting Sports & Leisure by writing to Towergate House, St Edward s Court, London Road, Romford, Essex RM7 9QD, or by telephoning for further information. If you are aged under 18 at the time of applying for this Insurance, the above declaration must be read and the statements agreed with, on your behalf, by your parent or guardian. Direct Debit Guarantee This guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme. The efficiency and security of the scheme is monitored by your own Bank or Building Society. If the amounts to be paid or the payment dates change, you will be told at least 14 days in advance. If an error is made by CCV Underwriting Sports & Leisure or by your Bank or Building Society, you are guaranteed a full refund by your branch. You can cancel a Direct Debit instruction at any time by writing to your Bank or Building Society, please also send a copy of your letter to CCV Underwriting Sports & Leisure. Personal Data The Insurer for policies underwritten under this scheme is Prosight Syndicate 1110 at Lloyds. To set up and administer your policy the insurers and CCV Underwriting Sports & Leisure will hold and use information about you supplied by you. They may send it in confidence for processing to other companies in their group of companies or those acting on their instructions including those located outside the European Economic Area. CCV Underwriting Sports & Leisure may also send you details of their other products and services. Please tick this box if you do not wish to receive such details 5

6 Application Form and Premium You must give full and true answers to all questions. If You do not do so, Your insurance cover may not protect you in the event of a claim. Name of Golf Club (if applicable) Date Cover Required Name of Golfer Home Address Postcode Please tell us where did you hear about this product? COVER REQUIRED (please tick) Cover Premium Standard UK Only Standard + All Risks Optional Extension 1 (excluding USA and Canada) Standard + All risks Optional Extension 2 (including USA and Canada) Prices shown includes 6% insurance premium tax and 6.00 Policy Fee STANDARD COVER Cover Limit Golf Equipment (UK only) 1,500 Personal Effects 500 Personal Accident Benefits 50,000 Liability for damage to third parties 5,000,000 Hole in One 100 OPTIONAL EXTENSION 1 Golf Equipment increased to 2,000 and applies Worldwide (excluding USA and Canada) for journeys of up to 30 days duration prices shown include 6% insurance premium tax. OPTIONAL EXTENSION 2 Golf Equipment increased to 2,000 and applies Worldwide (including USA and Canada) for journeys of up to 30 days duration prices shown include 6% insurance premium tax. Date Cover Required / / I have read and understood the Declaration and agree with the statements made without reservation. Date Signature of Applicant Date / / To be signed by parent or legal guardian if applicant aged under 18 at time of application. A copy of the completed proposal form will be supplied on request within a period of 3 months after its completion. The applicant should keep a record of all information provided to the insurer including copies of letters. I have read and understood the Declaration and agree with the statements made without reservation. Please complete the application and direct debit form and return to us at the address below: CCV Underwriting Sports & Leisure Towergate House, St Edwards Court, London Road, Romford, Essex RM7 9QD Telephone: Fax: CCV Underwriting Sports and Leisure is a trading name of CCV Risk Solutions Limited Registered in England & Wales at Towergate House, Eclipse Park, Sittingbourne Road, Maidstone, Kent, ME14 3EN. Company number Authorised and Regulated by the Financial Conduct Authority 6935/236/PF/08.13/16239

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