Travel Insurance Application - Danforth Insurance

Quotes Accepted:

Coverage dates: January 7, 2929 to January 12, 2909

Applicant	Plan Type	Coverage*	Premium	Tax	Total
1	Emergency Medical Only (Plan B) Baggage, flight and travel accident added (Plan C)	Preferred medical plan - $5,000,000 coverage $1,000 Baggage Loss, $500 Baggage delay, $50,000 travel and $100,000 Flight Accident	Plan B: $1000.00 Plan C: $000.00	$10.00	$1000.00
2	Trip Cancellation Only (Plan A) Baggage, flight and travel accident added (Plan C)	$150 amount covered before departure and unlimited coverage after departure $1,000 Baggage Loss, $500 Baggage delay, $50,000 travel and $100,000 Flight Accident	Plan A: $1000.00 Plan C: $000.00	$10.00	$1000.00
3	Emergency Medical and Trip Cancellation (Plan E) (includes baggage, flight and travel accident coverage)	5,000,000 emergency medical coverage $150 amount covered before departure and unlimited coverage after departure $1,000 Baggage Loss, $500 Baggage delay, $50,000 travel and $100,000 Flight Accident	Plan E: $1000.00	$10.00	$1000.00
3	Emergency Medical and Trip Cancellation (Plan E) (includes baggage, flight and travel accident coverage)	5,000,000 emergency medical coverage $150 amount covered before departure and unlimited coverage after departure $1,000 Baggage Loss, $500 Baggage delay, $50,000 travel and $100,000 Flight Accident	Plan E: $1000.00	$10.00	$1000.00
3	Emergency Medical and Trip Cancellation (Plan E) (includes baggage, flight and travel accident coverage)	5,000,000 emergency medical coverage $150 amount covered before departure and unlimited coverage after departure $1,000 Baggage Loss, $500 Baggage delay, $50,000 travel and $100,000 Flight Accident	Plan E: $1000.00	$10.00	$1000.00

* Conditions apply: download policy document for more details.

Minimum Adjustment Charges:

Total Premium:

Applicants Information

Applicant 1 (Birthdate: January 2, 2020)

Given Name(s) *

Last Name *

Gender *

Age 40 years

Applicant 2 (Birthdate: January 2, 2020)

Given Name(s) *

Last Name *

Gender *

Age 40 years

Applicant 3 (Birthdate: January 2, 2020)

Given Name(s) *

Last Name *

Gender *

Age 40 years

Applicant 4 (Birthdate: January 2, 2020)

Given Name(s) *

Last Name *

Gender *

Age 40 years

Applicant 5 (Birthdate: January 2, 2020)

Given Name(s) *

Last Name *

Gender *

Age 40 years

Address in Canada

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