Canadian Independent Travel Insurance Advisors & Brokers

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E-Mail:
daniel.latour@
justincaseinsurance.com

MSN Messenger:(Live Chat)

latourdaniel@msn.com

Skype:
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:
1-888-637-2636

Courrier Address:
147 Place Terry Fox
Kirkland, Quebec
CANADA H9H 4Z5

Regional Offices:
410-2001
McGill College Avenue
Montreal, Quebec
CANADA H3A1G1

200-1122 4 Street SW
Calgary, Alberta
CANADA T2R1M1

Guaranteed Issue Life Insurance to Protect Your Family

No Medical Exams

No Doctor's reports

No needles

more info...

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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. We are excited about our INSTANT ONLINE TRAVEL INSURANCE QUOTE & BUY capability provided by our partnership with ETFS. CLICK HERE if you'd like to obtain an instant quote with ETFS. You can also consult our new Guide to Travel Health Insurance for July 2008 Or, 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. Choose which options to include in your quote Trip Cancellation Trip Interruption Accidental Death & Dismemberment All Inclusive Holiday Travel Plan Baggage Insurance Your Personal Data:

Your Name:
Street Address:
City:
Province:
Postal Code:
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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