Visitors to Canada - Platinum Insurance Online Quote-Application Form

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  1. Maximum period of coverage: 365 days.
  2. Minimum premium is $20.00.
  3. Effective date must be at least 72 hours from the 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

Effective Date : Y/M/D

 

Expiry Date : Y/M/D

 

Number of Days Coverage

Days

No. 1

Year (4 digits) / /

M F

$ /

$

No. 2

Year (4 digits) / /

M F

$ /

$

No. 3

Year (4 digits) / /

M F

$ /

$

$

Please fill in the following.

 

 VISA    MC    AMEX  

/

Declaration

I (We) confirm that I am (we are) in good health and that I (we) know of no reason for which I (we) may seek medical attention.

I (We) confirm that I (we) have not seen a physician or other registered medical practitioner since my (our) arrival in Canada.

I (We) confirm that I (we) have not submitted a claim and no circumstance is known for which a claim may be made.

I (We) understand that if this policy is purchased within 60 days of my (our) arrival in Canada, there is no coverage for sickness occurring or arising during the first 48 hours from the effective date of this policy.

I (We) understand that if this policy is purchased more than 60 days after my (our) arrival in Canada, there is no coverage for sickness occurring or arising during the first 7 days from the effective date of this policy.

I (We) understand that the medical conditions disclosed on this application are basically not covered and that details of when pre-existing conditions are covered are set out in the policy booklet.

I (We) understand that their will be basically no coverage for any sickness or symptom occuring before the effective date (a pre-existing condition exclusion may apply to me (us)). I (We) have read and agreed the policy booklet for details on the pre-existing condition exclusion that may apply to me (us).

I (We) hereby authorize any hospital, physician or other person or organization that has records or knowledge of my (our) health or medical history to provide that information to the company (as defined in the policy booklet) and Claims at TuGo and I (we) authorize the company and Claims at TuGo to use and disclose that information to determine whether any claim that may be made is covered by this policy or by another plan or policy.

I (we) or any representative purchasing insurance on the applicant(s)’s behalf consent(s) to TuGo and Claims at TuGo collecting, using and disclosing my (our) personal information only for the purposes of approving your insurance application, confirming coverage and/or benefits, and processing your claims. I (We) have read and agreed to TuGo’s Privacy Policy, which is available at https://www.tugo.com/en/privacy/.

The applicant who submits this online application form hereby certifies the information he/she sends by online is true and accurate.

The applicant who submits this online application form hereby confirms that every person named on this application confirms the avobe statements are true and understands the above conditions.

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