Travel Insurance Price Quote

Fill out this form for a no obligation travel insurance quote. Please answer each question as best you can. Every province has their own regulations when it comes to insurance so we have to know where you live to be able to quote correctly.

Full name

First name*

Last name*

Birthday*

Phone number*

Email*

Address

Line 1

Line 2

City

Province*

Postal Code

Country

Names of additional travellers and dates of birth

Do all travellers live at the same address?

What type of coverage are you looking for? (check all that apply)*?

Comprehensive Single-trip Plan

Emergency Hospital & Medical

Non-medical Package

Trip Cancellation & Interruption

Visitors to Canada Travel Medical

Comprehensive Multi-Trip Plan

Emergency Hospital & Medical Multi-Trip Plan

Are all insureds covered for medical under a valid government health insurance plan?*

Yes

No

Not sure

Start date of travel*

Return date of travel (must be date that you return to Canada)*

Where are you travelling to?*

What is the total value of the trip you are insuring?*

Which West Canadian Travel consultant do you work with?*

*if "other" was selected please enter name of Travel Consultant

Type
Draw

×

By signing, I understand that this is a legally binding contract.