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Visitors to Canada - TIC Travel Insurance Online Quote-Application Form
  • Please fill in the required information then click 'Preview' to review and confirm your information in the Preview Screen, then and click 'Submit' if your information is correct.

  • Notes:
    1-
    Maximum period of coverage: 365 days.(366 days in leap year)
    2-
    Minimum amount of premium: $20
    3-
    You must meet the eligibility in the policy wording.
    4- Effective date must be at least 24 hours from application time.
    5-
    Please give us an e-mail if you are qualified for the family rate, we will adjust the premium.

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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

SUM INSURED

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 at Effective Date
Total
Date of Birth : Y/M/D                    Gender    
1 $ / $
Year (4 digits) / / M F
2 $ / $
Year (4 digits) / / M F
3 $ / $
Year (4 digits) / / M F
4 $ / $
Year (4 digits) / / M F
5 $ / $
Year (4 digits) / / M F
Tax $
Total $
Please fill in the following.
Address in Canada:
City/Province:
Postal Code:
Tel.:
email:
Country of Origin:
Death Benefit Beneficiary:
Relationship:
Previous policy Number: * If you are renewing your plan
TIC
Date of Entry to Canada: Y/M/D
Pay by: VISA   MC   AMEX  
Expiry Date: M/Y: /

Card Number:

Card Holder Name

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Confirm
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All the data