Bridges International Insurance Services A division of KRG Insurance Brokers (Western) Inc. Canada Travel Insurance, Travel Insurance, Visitors to Canada

Visitors to Canada - Travel Insurance Online Quote-Application Form

Maximum period of coverage: 365 days.
Minimum amount of premium: $20
You must meet the eligibility in the policy wording.
Effective date must be at least 24 hours from application time.

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

Expiry Date : Y/M/D

Number of Days Coverage

Days

No. 1

First Name :

Last Name :

Date of Birth : Year (4 digits) / /

Gender : M F

Daily Rate / Age at Effective Date :$ /

Premium : $

No. 2

First Name :

Last Name :

Date of Birth : Year (4 digits) / /

Gender : M F

Relationship with 1

Daily Rate / Age at Effective Date :$ /

Premium : $

No. 3

First Name :

Last Name :

Date of Birth : Year (4 digits) / /

Gender : M F

Relationship with 1

Daily Rate / Age at Effective Date :$ /

Premium : $

Total: $

Please fill in the following.

Visiting province/territory

Who is purchasing the policy?

Mailing Address in Canada:

Suite No.

City/Province:

Postal Code:

Tel:

Email:

Email (Confirmation):

Pay by: VISA MC AMEX

Card Holder Name:

Card Number:

Expiry Date: M/Y: /

CVV:

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