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  • Toronto Chinese
    Health Insurance for Visitors
    to Canada Pre-Application eForm


    ¡¡¡¡To apply for health insurance for visitors to Canada, you might complete the following form and submit it to us. Once we receive your form, we will call you to answer your questions, confirm and complete your application. If you like to submit the form by fax, you might print the form (Print Pre-application eForm), complete it and then send it to us by fax. Also, you might come to our office to purchase it.

    ¡¡¡¡For some companies£¨GMS£¬, ETFS, TG£©, you might also purchase it online by yourself. To do it, click the "Buy Online" link of respective company in our web site, and follow the instruction. If there is any question you like to consult us before you buy it online, you are also very welcome to contact us.


      Subject:
      1¡¢Your Name*: (* required)
      2¡¢Your Title£º Mr. Mrs. Ms.
      Miss Dr.
      3¡¢Phone No.:
      4¡¢Email*: (* required)

      5¡¢Insured person's name, D.O.B; in order of surname, first name & dd/mm/yy:
      1)
      2)
      3)
      4)
      5)

      6¡¢Address in Canada£º


      7¡¢Arrival Date in Canada:
      8¡¢Effective Date:
      9¡¢Expiring Date:

      10¡¢Coverage in CND$: $10,000 $15,000
      $25,000 $50,000 $100,000 $150,000 $200,000

      11¡¢Company Interested:

      12¡¢Your Message:
    or