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Additional InformationPlease fill in the appropriate informationDate of Travel Departure (DD/MM/YYYY)
Date of Travel Return (DD/MM/YYYY)
Destination: including locations of transfer or layover
Name and age of each traveller – related/unrelated
Anyone traveling take more than two medications?
If yes, please list all medications…
Is anyone traveling pregnant?
If yes, please provide due date and confirm drs approval for travel has been acquired
Is anyone traveling suffering from a critical or chronic illness?
If yes, please describe
Do you require trip cancellation?
Do you require baggage coverage?
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Dominion - 1-800-661-5522
Travelers - 1-800-661-5522
Economical – 1-800-607-2424
Intact – 1-866-464-2424
Aviva – 1-866-692-8482
April Canada – contact our office during regular business hours
RSA Facility – 1-800-319-9993
Premier Marine – 1-800-235-8784
Travel Underwriters – 1-800-663-0399
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