In consideration of the sum of
_____________________________________ United States Dollars (US
$_____) paid by the National Hockey League ("NHL") and/or Boston
Mutual Life Insurance Company ("Boston Mutual") subscribing to
the disability program of the NHL on behalf of each of the NHL's
Member Clubs ("Clubs"), the receipt whereof is hereby
acknowledged, the undersigned hereby confirms that he is
permanently disabled. 
         The undersigned hereby undertakes to return any and all
monies paid under this policy to the NHL and/or Boston Mutual if
the said undersigned returns and plays professional
hockey.

         The undersigned hereby acknowledges that this said
confirmation and Undertaking is given in consideration of the
payment of the sum of ___________________ United States Dollars
(US $_____) which is the subject amount of a Release attached
hereto and dated the _________ day of ________________, 199_.


                                          Signature of Player


                                          Typed Name of Player


Sworn to and subscribed  before me this _____ day of
___________________, 199_. 

_____________________________
      Notary Public

RETURN TO NHL CBA INDEX