We offer up to $150,000 CDN per person
for Emergency Medical & Hospital Insurance
Benefits
We also offer you a comprehensive Benefit
Plan that can include Life Insurance, Accidental Death &
Dismemberment Benefits, Spousal Insurance, Dependent Insurance,
Weekly Indemnity, Short Term/Long Term Disability Benefits,
Comprehensive Medical & Prescription Drugs, Dental &
Vision Care Benefits
If you would like us to shop with a
variety of carriers, fill in the form below, we will do price
comparisons, and e-mail or call you.
Tell Us About
Yourself:
Province:
E-Mail (REQUIRED):
E-Mail again for
accuracy:
Phone:
Fax (optional):
Marital
Status:
Single Married
Homeowner?
Yes
No
Currently
Insured?
(If yes, list carrier, and # of years continuous. If none, type N/C)
Unusual
Activities?
(If you engage in unusual activities such as
scuba diving, airplane flying, rock climbing, etc., list them
here.)
Select Type of Plan
You are Looking For:
Individual Plan
Married
with Spouse Included
Family
Plan
Underwriting
Information:
Sex
(M/F):
Smoker
or
Non-Smoker?:
Height:
Weight:
This best
describes my personal
situation:
International Student studying in
Canada
Diplomat
on assignment in Canada
Visitor to
Canada with Work Permit
Visitor in
Canada without Provincial Health, Drug & Dental
Insurance
Landed
Immigrant without comprehensive Health, Drug &
Dental Insurance
Refugee
without Provincial Health, Drug, & Dental
Insurance
Other
If adding spouse or
family plan, list each person adding:
List Any Dental or
Health Problems:
List Any Medication You
Take:
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 purpose. 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.
Yes, I Agree. Please Send Me a
Visitor To Canada Insurance Quote
NOW!
Click Button Below When Done
Click
Button Below When Done
Please Click Only Once . . . May take up to 30 seconds!
Daniel La
Tour is our Licensed Life Insurance Agent in BC, AB, ON & QC.
For help and advice, contact Daniel La Tour.
Call NOW! 1-888-977-7778 (toll
free)
(Monday-Friday 9-9, Saturdays
11-5, EST.
Our International Number is: 1-514-630-6116)
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
Investment Fund
Companies
Fidelity
Mackenzie Financial
Transamerica
Canada Life
Manulife Investments
AGF
