Ontario Broomball-Insurance

Federations of Broomball Association of Ontario

Insurance

Insurance is provided by All Sport Insurance Marketing Ltd.

Please send the original completed form along with any invoices for expenses you had to pay yourself to:

Lesley Squibb

22 Bellefield Crescent
Box 358
Arthur, ON N0G 1A0

lesley.squibb@ontariobroomball.ca

Form: Accident Claim Form

Note: CERTIFICATION OF ASSOCIATION OR CLUB EXECUTIVE section will be completed by the F.B.A.O. Secretary. Please do not fill in any section of this box in any way. Do not send your claim directly to All Sport as they will not be able to process it.

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◦	2009 Provincial Awards Night

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Banner photos courtesy of Heather Dietz Photography

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