International Student Insure Canada Application | Danforth Insurance

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Trip details

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Your quote

Traveller details

Payment

Confirmation

Coverage dates: January 7, 1980 to January 10, 1982

Quotes Accepted:

Applicant	Student Plan	Coverage	Deductable	Premium
1	Enhanced	$200,000	$10,000	$10,000.00
2	Enhanced	$200,000	$10,000	$10,000.00
3	Enhanced	$200,000	$10,000	$10,000.00
4	Enhanced	$200,000	$10,000	$10,000.00
5	Enhanced	$200,000	$10,000	$10,000.00

Total Premium:

Applicants Information

Applicant 1 (Birthdate: January 31, 2020)

Given Name(s) *

Last Name *

Gender *

Applicant 2 (Birthdate: January 31, 2020)

Given Name(s) *

Last Name *

Gender *

Relationship to Primary Applicant*

Applicant 3 (Birthdate: January 31, 2020)

Given Name(s) *

Last Name *

Gender *

Relationship to Primary Applicant*

Applicant 4 (Birthdate: January 31, 2020)

Given Name(s) *

Last Name *

Gender *

Relationship to Primary Applicant*

Applicant 5 (Birthdate: January 31, 2020)

Given Name(s) *

Last Name *

Gender *

Relationship to Primary Applicant*

Beneficiary in case of death

Beneficiary name *

Relationship to insured *

Address *

City *

Country *

Travel Information

Country of origin: *

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Destination province: *

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Address in Canada

Street Adress: *

City: *

Province: *

Home Phone: *

Postal Code: *

Email: *

Confirm Email: *

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