Application for Visitors to Canada Insurance

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First  / Last Name

Date of Birth

Gender

Coverage for Pre-existing condition

Applicant 1

First and Last Name

Date of Birth

Do need coverage for Pre-existing Medical condition?

Applicant 2

First and Last Name

Date of Birth

Do need coverage for Pre-existing Medical condition?

Applicant 3

First and Last Name

Date of Birth

Do need coverage for Pre-existing Medical condition?

Applicant 4

First and Last Name

Date of Birth

Do need coverage for Pre-existing Medical condition?

Applicant 5

First and Last Name

Date of Birth

Do need coverage for Pre-existing Medical condition?

Amount of Coverage for each Applicant

Date of arrival in Canada

(for Super Visa Application Insurance just enter tentative Date of Arrival)

Effective Date

Expiry Date

(for Super Visa application, minimum number of coverage days is 365)

Questions?  Call us at 1-877-443-0101 or

ask your question online

FOR ALL REQUESTS:

We will respond by email within 24 hours.

FOR SUPER VISA APPLICATION:

- If you need insurance to apply for Super Visa, please enter a tentative arrival/effective date. This date will be adjusted when you (or your parent(s)) obtain Super Visa.

- Minimum number of coverage days is 365. If the visitors return home early (before the policy expiry date), a partial refund will be available for the unused number of days provided there is no claim submitted or reported in the policy.

TO APPLY FOR INSURANCE:

If you would like to apply for insurance, please fill in all the fields (including Address in Canada and Phone number), provide your valid email and click on “SUBMIT”.

We will email you your final Application from the insurer with quotes and payment options available.

TO GET A QUOTE:

If you want to get a quote only, please complete the following sections: "Applicant Information" and "Trip Information".

Please provide your valid email and click on “SUBMIT”. Your Quote will be sent to you by email.