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Canada's Widest Range of Super Visa Insurance and other Visitor to Canada Products

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Information Request Form - Individual Insurance

We have contracts with close to 30 top insurers in Canada. No case is too tough even if you have been previously rated or declined, we can help! Policies include: Life, disability, long-term care, and critical illness insurance. RRSP, RESP, and other investment opportunities. Click Here

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Head Office: 9915 65 Avenue NW, Edmonton, AB, T6E 0L1

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Tell us your travel details

Please select plan you want
Select your province
Select Trip Type
Choose Plans
Select Trip Destination
Are you applying under the Super Visa Program for Parents & Grandparents Program?
Maximum Coverage Amount
Days of Coverage
Trip Cancellation Benefit
Please list the dollar value of the non-refundable portion of your trip, rounded to the next $100
Date of Birth(s)
Start Date
End Date
Have you used tobacco within the past 5 years?
Do you have any pre-existing medical conditions?