To obtain a quote for travel insurance, please complete the online form below. For travellers of age 60 or older, we will also require answers to the following medical health questionnaire (see PDF link here): Travel Medical Health Questionnaire (For BC Travellers of age 60+) COVID-19 Medical Health Questionnaire (For BC Travellers purchasing COVID-19 Medical Coverage) Please note: the information that you provide in this questionnaire will be used to determine your premiums and eligibility for insurance, and you are responsible for the accuracy of the answers you provide. If you falsely describe or fraudulently omit any fact that is material to the insurance company in order for it to be able to judge the risk, your insurance policy may be void. Please ensure that you fully understand the answers that you are providing when completing this questionnaire; if you are unsure of some of these details, we strongly recommend that you obtain professional advice. You are welcome to contact our office with any questions you have about this questionnaire. Name: Address: City: Province: Postal Code: Phone number: Email: Date Leaving Home Province: Calendar Date Returning to Home Province: Calendar Destination: (select country) Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia-Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (Dem. Republic) Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Island of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (Democratic Republic of) Korea (Republic of) Kosovo Kuwait Kyrgyz Republic Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldavia Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua-New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Re union Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay USA Uzbekistan Vanuatu Vatican (Holy See) Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe Destination (If Other Than Above): Are all travellers BC residents AND covered by BC provincial health plan: YesNo Have any travellers been diagnosed with a terminal condition: YesNo Is anyone travelling against a medical practitioner's advice: YesNo Has anyone received or been recommended for palliative care: YesNo What coverages are you interested in obtaining (select all that apply): Travel Medical OnlyCOVID-19 Medical EnhancementMedical Enhancement for Sports & ActivitiesTrip Cancellation (pre-departure)Trip Interruption (after effective date)Baggage InsuranceAnnual Multi-Trip Policy (instead of single trip) Insured #1Name (as on Passport): Date of Birth: Calendar Sex: Male Female Pre-existing conditions: None Yes - Answer on Medical Health Questionnaire Upload Medical Questionnaire (if applicable): Insured #2Name (as on Passport): Date of Birth: Calendar Sex: Male Female Pre-existing conditions: None Yes - Answer on Medical Health Questionnaire Upload Medical Questionnaire (if applicable): Security code: Please note, email is not a secure method of transmitting sensitive personal information and by using this service you accept this risk. 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