info@inslyf.com

+1 905 901 1717

Mon to Fri - 10am to 5pm

Travel Insurance - Application Form

-

1^st Traveller Detail

First Name (*)

Middle Name

Last Name (*)

Gender

Age

Deductible

Sum Assured

Insurance Effective Date

Insurance Expiry Date

Premium Amount

Number Of Days

Sponsor Information

Contact Person (*)

Telephone (*)

Ext.

Email Address (*)

Alt. Telephone

Beneficiary Name

Best time to reach (*)

Continue

Contact Information. Please Fill it out:

Canada Address(*)

City (*)

Province (*)

Zip Code (*)

Origin Country

Start Date Of Trip

Canada Arrival Date

Message

I have read the privacy policy

Continue