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1 Informations

2 Summary

3 Payment

Informations

Start purchasing your insurance policy now by selecting the desired coverage period and completing the following fields. Would you like your policy to be issued immediately? Click here to access the insurer's platform and make your request.

Your plan

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Total

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Choose the duration required for your insurance*

Insurance start date

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Eligibility requirements

Please read the eligibility criteria, terms regarding pre-existing health conditions and the privacy statement carefully before agreeing to the primary insured's statement. For any questions or uncertainties, please call 1-800-607-1920 or Chat with us!

Traveler information

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Full address of the insured in Canada

Additional information

Would you like to add your dependents to your coverage? Enter their personal details (surname, first name, date of birth) and our team will contact you to adjust your rates.

Summary

Be sure to check that all the following information is correct, as it is required to provide you with travel insurance services and to issue a policy. If this is not the case, click on "modify" to make the changes. The premium amount may change according to the new information provided.

Your plan

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Total

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Insurance start date

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Choose the duration required for your insurance*

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Eligibility requirements

Traveler information

Traveler information

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Gender*

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Address*

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Pre-existing health conditions

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Additional information

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I confirm (on behalf of all travellers listed in this contract) that I accept the terms and conditions of the insurance coverage, and that I understand what is not covered. I am aware of the premium costs associated with this application and I agree to pay the associated fees. I confirm that the information provided is accurate, and I acknowledge that any false declaration will result in the cancellation of the insurance. In case of doubt, I have contacted Assurance Visiteurs.

I confirm that by providing the personal information of all insureds in the submission, I have obtained the consent of all insureds to provide the personal information to Assurance Visiteurs and the insurer. I confirm that I am the parent or guardian of any minor insured or that I have obtained consent directly from the parent or guardian of such minor to share his or her personal information.

I confirm that by purchasing this travel insurance, I agree and consent to Visitor Insurance and its agents collecting, processing, distributing and retaining the personal information collected for the purpose of providing and administering travel insurance and conducting internal research and analysis in accordance with the stated Privacy Policy. I understand that this information will be retained for a minimum period of 5 years as required by Assurance Visiteurs’ regulatory obligations.

I confirm that by purchasing this travel insurance, I authorize Assurance Visiteurs and its agents to share my personal information for the duration of the insurance coverage with insurers, service providers and partners. This personal information may be shared with agents, brokers and credit card processors to facilitate the provision of travel insurance services. This information may be shared outside Quebec (if a resident of Quebec) or Canada for the purposes of insurance application, assistance services, claims processing and dispute resolution.

I understand that my medical history will be reviewed in the event of a claim. In order to make a proper assessment the Insurer may, with my written consent, obtain all available medical information from any health care organization concerning my medical history. I understand that if I refuse to sign the written authorization, the insurer will deny the claim.

I consent to Assurance Visiteurs, its agents and suppliers communicating with me, during the term of my coverage, the information required to maintain and renew my policy. Without limitation, such communications may be for informational purposes or in connection with a request for service in the event of a claim. Consent may be withdrawn at any time.

If you are applying for a policyholder other than yourself, please complete this section.

If this request concerns a person other than yourself (e.g. spouse, parent, sibling, friend, client, etc.) or more than one person to be insured, that person must consent to the transmission of his or her personal information. Under Quebec’s Bill 25, each person must consent to the collection and transmission of his or her personal information. The person to be insured must read this consent form, sign it and return it by e-mail to info@assurancevisiteurs.ca within the next 24 business hours. In the case of minors, this authorization must be signed by a parent or guardian. After this time, the policy will not be activated.

Optional

I would like to be contacted by a financial security advisor to find out more about the range of individual products (life, disability, critical illness, car/home insurance and other savings products).

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Informations

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By clicking “Submit” I agree and consent to Assurance Visiteurs and its agents collecting, processing, distributing and retaining the personal information collected for internal research and analysis in accordance with the stated Privacy Policy.