SSL
CANADIAN TRAVELLERS Online Quote-Application Form
  • Please fill in the required information then click the 'Preview' button, Review your information and click 'Submit' in the next page to apply



  • In consideration of the application for insurance and payment of the appropriate premium, and subject to the terms, conditions, limitations, exclusions and other provisions of this policy, the insurer will pay the reasonable and customary costs for eligible expenses incurred during the period of coverage, up to the amounts specified in this policy, in excess of any deductible and the amount allowed and/or paid for by any other insurance plan(s). Payment is limited to the amounts specified under each coverage option. Some benefits are subject to advance approval by Allianz Global Assistance. You will be responsible for any expenses that are not payable by the insurer.

  • If you are 60 year and over, please call or e-mail us for rates and details of coverage.


  • Effective date must be at least 24 hours from application time.


  • If you would like to apply for the Multi-trip Plans or the Optional Plans, please call or e-mail us for the application form.


  • This coverage shall be void and the premium paid refunded if:

    1. purchased or Effective after departure, or if purchased for a Trip not originating in Canada, unless authorization has been provided by Allianz Global Assistance,
    2. the entire Trip is cancelled prior to departure,
    3. the Insured is not a Canadian Resident.


  • If you are qualified for Family Rate, please call or e-mail us. We will adjust the premium.


  • For Windows users to view this page correctly, please use IE6.0, Netscape7.1, Opera7.5 or Firefox0.9 or higher.  For Macintosh users to view this page correctly, please use Netscape7.1, Opera7.5 or Firefox0.9 or higher.


  • Privacy Policy
Fill in the information in the light blue shaded boxes, then click the quotation button below.
It will automatically quote the number of days coverage and the total cost of the insurance.
<= Quotation Button

Plan Destination

Effective Date : Y/M/D
Click the calendar
(at least from next day)
Expiry Date : Y/M/D
Click the calendar
 
Number of Days Coverage
Days

No. First Name Last Name Daily Rate / Age Total
Date of Birth : Y/M/D                    Gender    
1 $ / Age $
Year (4 digits) / / M F
2 $ / Age $
/ / M F
3 $ / Age $
/ / M F
4 $ / Age $
/ / M F
5 $ / Age $
/ / M F
      Tax: $
      Total: $
Please fill in the following.
Address in Canada:
City/Province:
Postal Code:
Tel.:
email:
Death Benefit Beneficiary: * *Optional
Relationship:
Previous policy Number: * If you are renewing your plan. .
TIC
Pay by: VISA MC AMEX
Expiry Date: M/Y: /

Card Number:

Card Holder Name

Preview and
Confirm
Clear
All the data