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Manjit Kaur Bola

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Health insurance covers up to $200000. Please read the policy before filling out the application.

This product is underwritten by Industrial Alliance Insurance and Financial Services Inc.
What is your birth date? 

TRAVEL AND TRIP INFORMATION

Effective Date of this policy
Termination Date of this policy
OR Duration of coverage days
Coverage Details:    
Application Type? A monthly billing option is only available for Super Visa, Visitor (365 days minimum).
For shorter trips, select Visitor, Immigrant, Returning Canadian.



Note: Super Visa requires a single application for each party.

Note: This applies only if you are a student registered at a Canadian School.
Family, Couple or Single Coverage?
Note: Family denotes two adults plus dependants, Couple denotes two adults only.
The Birth Date of the eldest member must be used above.
Health Coverage: (Choose the desired limit)  
Do you want Accidental Death coverage? (optional) starting from $20.00 to $117.75 depending on age
Allowances:    
Have you purchased a policy from us last year?
 
Is your travelling companion insured by us? (Receive a 5% allowance.)
Companion's name:
     
Have you been fully vaccinated for COVID-19?
(the answer to this question determines COVID-19 related coverage)
Yes: Coverage up to $200,000 for the costs of medical care provided by hospitals and physicians
No: Losses related to Covid-19 are not covered
Notes
Please enter any additional, pertinent information and any other information relating to your health here: (500 characters)

PRE-EXISTING CONDITIONS ARE NOT COVERED WITH THIS APPLICATION.


Available Actions: