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Universal Financial Strategies Inc

1 (877) 553-5678

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Health insurance covers up to $$200,000. Please read the policy before filling out the application.


What is your birth date? 

TRAVEL AND TRIP INFORMATION

Effective Date of this policy
Termination Date of this policy
OR Duration of coverage days
Coverage Details:    
Application Type?
Super Visa offers a monthly billing option
Super Visa
Visitor, Immigrant, Returning Canadian
Note: Super Visa requires a single application for each party.
Family, Couple or Single Coverage?
Note: Family denotes two adults plus dependants, Couple denotes two adults only.
The Birth Date of the eldest member must be used above.
Coverage: (Choose the desired limit)  
Country of origin:  
Allowances:    
Have you purchased a policy from us last year?
Yes No
 
Is your travelling companion insured by us? (Receive a 5% allowance.)
Yes No
Companion's name:
Notes
Please enter any additional, pertinent information and any other information relating to your health here: (500 characters)

PRE-EXISTING CONDITIONS ARE NOT COVERED WITH THIS APPLICATION.


Available Actions: