JustinCase. ™. Canadian, USA & Worldwide Travel Insurance Brokers & Advisors. Free Online Insurance Quotes, Info, Advice & Financial Services. Licensed in BC, AB, ON and QC

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Daniel La Tour

1-888-977-7778 Monday-Friday 9-9, Saturdays 11-5, EST. Our International Number is: 1-514-630-6116

Toll-Free Fax:
1-888-245-5505

World Headquarters:
147 Place Terry Fox
Kirkland, Quebec
CANADA H9H 4Z5

Guaranteed Issue Life Insurance to Protect Your Family

No Medical Exams
No Doctor's reports
No needles

more info...

Call NOW! *1-888-977-7778* (toll free) (Monday-Friday 9-9, Saturdays 11-5, EST. Our International Number is: 1-514-630-6116) Save Time & Money. Free, Fast & Easy To Apply. Travel Insurance Quote Request Travel insurance covers medical and accident losses while abroad, and can include trip cancellation coverage, loss of baggage, medical, emergency assistance, and life coverage as well. If you would like us to shop and compare insurance rates for your best value buy, fill in completely the Request To Quote Form below and we will contact you today. Choose which options to include in your quote Trip Cancellation Trip Interruption Accidental Death & Dismemberment All Inclusive Holiday Travel Plan Baggage Insurance Tell Us About Yourself

Province:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Home Phone:
Work Phone:
Fax (optional):

Marital Status: Single Married	Choose Option: Option 1= Coverage for any new sickness or new injury only. Option 2= Coverage for pre-existing medical conditions, along with coverage for any new sickness or newinjury.

Departure Date:

Return Date:

Departure City:

Destination City:

Number of Days Coverage?
(Standard number of days covered choices are: 2, 4, 8, 15, 30, 60, or 90 days.)

Any Unusual Activities?
(If you will engage in unusual activities such as scuba diving, airplane flying, rock climbing, etc., list them here.)

This best describes my travelling situation:

Visitor to Canada with Work Permit
Canadian Waiting for Provincial HealthInsurance
Canadian Travelling Inside Canada
Canadian travelling Outside Canada
Visitor in Canada without Provincial HealthInsurance
Health Travel Insurance Outside Canada (for Canadians)

Underwriting Information:

Insured Name: Birthdate: Travel companion # 1 Name: Birthdate: Travel companion # 2 Name: Birthdate: Travel companion # 3 Name: Birthdate:

Baggage & Personal Effects Values:	$

Cost of Trip to be Covered?	$

Amount of Life Ins. Desired?	$

Any special Medical Coverage Desired? (You may list dollar amount or type of medical coverage you want):

Reason for Buying Insurance:

Send my quotation via:	E-Mail Fax Regular Mail Call Me by Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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Travel Insurance Quote NOW!

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Daniel La Tour is our Licensed Life Insurance Agent in BC, AB, ON & QC.
For help and advice, contact Daniel La Tour.

We do business with....

Insurance Carriers

Transamerica
Empire Life
Great-West Life
Manulife Financial
Blue Cross
AXA
RBC Insurance
Canada Life
Unity Life of Canada
Sun Life Financial
Lloyd’s of London
Travel Underwriters
ETFS
Green Shield
Canada Protection Plan