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New Immigrants: FREE Travel Insurance Quote

Brought to You by Prof-Med

A Division of Professional Planning Solutions Inc.

Please tell us a little more about your planned trip

 

Persons to be Insured

All Fields Marked With An Asterisk (* ) Indicate A Required Field. Your Quote Can Only Be Provided Based On Complete Information.

This form allows for the names of four (4) insured persons. If you require a quote for more than four people, please complete the form again listing only the names of those who were left out of the previous submission.

1) First Name * *
1) Last Name * *
1) Date of Birth* *
2) First Name
2) Last Name
2) Date of Birth
3) First Name
3) Last Name
3) Date of Birth
4) First Name
4) Last Name
4) Date of Birth
Destination in Canada* *
Country of origin * *
Telephone Number * *
Application Date (Select today's date) * *
Effective Departure Date (When you will be leaving your home country)* *
Date of Entry (When you will arive in Canada) * *
Number of days coverage required * *
Any other information we should be aware of?
I understand that this coverage excludes treatment relating to pre-existing medical conditions * *
I and all the persons coverered under this policy are in good health and have no reason to seek medical attention * *
I hereby consent, personally and on behalf of all persons covered, to the release of all medical records in the event that there are any claims under this policy * *
I understand that no person covered under this policy, who is pregnant, will be covered for any treatments related to or arrising from the pregnancy. (Pregnancy is not covered under emergency medical cover) For more info contact us. * *
YES - I will also be taking the optional Death & Disablement coverage with this policy.
By checking this box, I acknowledge that all information provided by me in this form is correct and true.* *
I also hereby accept the ProfMed Conditions of Coverage as stated in the downloadable PDF Travel Insurance Policy. (If you agree, type "I Agree" into this box ->->) * *
My First Name * *
My Last Name * *
My Email Address (where we can send your quote) Please use a valid email address or you may not receive your quote. * *

Other Canadian Travel Insurance Options:
Canadian Travel Insurance - New Immigrants
Canadian Travel Insurance - Visitors
Canadian Travel Insurance - Students
Canadian Travel Insurance - Foreign Employees

 

 
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