TRAVEL INSURANCE PLANS

CANADIAN TRAVELLERS

CANADIAN TRAVELLERS FAX/Mail Quote-Application Form

Please fill in the required information then print it out, SIGN IT IN BOTH PLACES, and send it by mail or FAX to the address or FAX number below.

FAX:

Toll Free FAX:

Email

Address:

604-331-1042

1-888-298-6526

info@biis.ca

Suite 1406-1030 West Georgia StreetVancouver, BC, Canada V6E 2Y3
  • TIC pays in excess of your provincial plan for emergency hospitalization and emergency medical treatment up to $2 million if you are covered by a provincial or territorial health/medical plan, otherwise coverage is limited to $3,000.
  • If you are over 60 years old and the length of trip is over 60 days, please call or e-mail us for rates and details of coverage.
  • If you would like to apply for the Multi-trip Plans or the Optional Plans, please call or e-mail us for the quote-application form.
  • This coverage shall be void and the premium paid refunded if:
    1. purchased or Effective after departure, or if purchased for a Trip not originating in Canada, unless authorization has been provided by TIC,
    2. the entire Trip is cancelled prior to departure,
    3. the Insured is not a Canadian Resident.
  • If you are qualified for Family Rate, please call or e-mail us. We will adjust the premium.
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  • Privacy Policy
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
Plan Destination

Effective Date: Y/M/D

year is 4 digits, ie: 2009

Expiry Date: Y/M/D

year is 4 digits, ie: 2009 		No. of Days Coverage
/ / / / Days
* Please make sure you enter the correct day, as the drop down menu has 31 days available regardless of the month (eg. please do not enter Feb. 30 or 31 or April 31)
No. First Name Last Name Daily Rate / Age Total
DOB: Y/M/D
1 $ / Age $
year is 4 digits / /
2 $ / Age $
/ /
3 $ / Age $
/ /
4 $ / Age $
/ /
5 $ / Age $
/ /
      Tax: $
 

Total:

 $

Please fill in the following.

Address in Canada:
City/Province:
Postal Code:
Tel:
Email:
Beneficiary: *Optional Relationship:
Previous policy No.: * If you are renewing your plan.
TIC
Application Date: Y/M/D Time
/ / :
am pm
Pay by: VISA MC AMEX
ExpiryDate: M/Y /
Card Number:
Card Holder Name:

* Signature of card holder :____________________________________________________

I am in good health and know of no reason to seek medical attention. I am aware that if I have any condition affecting my health, claims relating this condition may be excluded under this policy.

The signatory confirms that every person named on this application is in good health and knows of no reason to seek medical attention.

*Insured's Signature ____________________________________________

Date: Y/M/D / /
Please fill in the required information then print it out, SIGN IT IN BOTH PLACES, and send it by mail or FAX to the address or FAX number below.