Name

Applicant 1:  

Age

Applicant 2:

Age

Applicant 3:

Applicant 4:

Applicant 5:

Province of Residence

Please choose Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Saskatchewan Yukon

Country of Primary Destination

(Where you are going to travel)

   Individual Coverage              Couple                     Family

Please enter the Total number of days per trip*             

*For Single-Trip plans and and Top-ups: Total trip length including your departure and return dates.

For Multi-Trip plans: Max number of days per trip

If you are topping up your existing travel medical insurance coverage,

please enter the number of days covered under your existing policy.

Emergency Medical Insurance

   Single-Trip Medical Plan             Annual Multi-Trip Medical Plan 

Non-medical Insurance

Please choose insurance plan you want to get a quote for:

  Single-Trip Plan                          Annual Multi-Trip Plan

The cost of Trip Cancellation & Interruption insurance depends on your trip cost (non-refundable and non-transferable portion of your travel arrangements). Please enter  this amount  below.

Trip Cancellation & Interruption  →     Trip Cost (sum insured per person)  $

Baggage Insurance      →    Baggage Cost (sum insured per person)   $

Date of Booking Your Trip              (ddmmmyyyy) 

 All -Inclusive Plan

May include Emergency Medical, Trip cancellation & Interruption, Baggage Insurance, Flight accident Insurance

  Single-Trip Plan                           Annual Multi-Trip Plan

The cost of this insurance depends on your trip cost (non-refundable and non-transferable portion of your travel arrangements). Please enter  this amount  below.

 All-Inclusive plan     →    Trip Cost  (sum insured per person)  $

Coverage for  Pre-existing Medical Conditions

E-mail      

Phone       (if you want an insurance broker call you)