TRAVEL INSURANCE PLANS

VISITORS TO CANADA

VISITORS TO CANADA 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
  • Maximum period of coverage: 365 days.
  • Maximum sum insured: $50,000 for persons age 71 to 85 except completion of a medical questionnaire.
  • Minimum period of coverage: 10 days per person.
  • Please give us an e-mail if you are qualified for the family rate, we will adjust the premium.
  • For Macintosh users to view this page correctly, please use any browser other than Internet Explorer.
  • 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 Basic Select
SUM INSURED

* Please choose either the Basic or the Select insurance plan.

Effective Date: Y/M/D

year is 4 digits, ie: 2008

Expiry Date: Y/M/D

year is 4 digits, ie: 2008 		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:
Country of Origin :
Beneficiary: *Optional Relationship:
Previous policy No.: * If you are renewing your plan.
TIC
Application Date: Y/M/D Time Date of Entry: Y/M/D
/ / :
am pm		 / /
Pay by: VISA MC AMEX
ExpiryDate: M/Y /
Card Number:
Card Holder Name:

* Signature :____________________________________________________

I declare that I am in good health and know of no reason to seek medical attention.

I understand that hospital and medical insurance excludes any sickness or injury occurring during the 180 days preceding the effective date. I also understand that sickness related coverage begins 48 hours from the effective date unless this coverage is purchased prior to arrival in Canada or before the expiry date of an existing TIC Visitors to Canada policy. The applicant who submits this online quote-application form 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.