Travel Insurance Quote

1. Contact Information

Name*

Company

Address 1 *

City/Town*

Province*

Postal Code*

Email Address*

Phone Number*

Please select either Multi Trip Annual Insurance OR Single Trip Insurance Options.

2. Multi Trip Annual Travel Insurance

3. Multi Trip Options

Multi trip worldwide

Multi trip within Canada

4. Single Trip

Departure Date:

Return Date:

5. Single Trip Options

Worldwide

Worldwide excluding USA (includes up to 5 days transit coverage in USA)

Within Canada

Please select either the Individual or Family Medical Insurance Option.Family Medical Insurance can cover couples without dependents however they have to be either married or common law partners. Family medical coverage does not include adult family members who are not either married or common law partners.

6. Who Is Travelling?*

7. Individual

Full Name:*Date of Birth

8. Family - Adults (Up to age 59)

1. Full Name:Date of Birth

2. Full Name:Date of Birth

9. Family - Dependents (Up to the age of 21 living at home or age 25 enrolled in school anywhere in the world)

1. Full Name:Date of Birth

2. Full Name:Date of Birth

3. Full Name:Date of Birth

4. Full Name:Date of Birth

5. Full Name:Date of Birth

10. Are you or any family member named above travelling against the advice of a doctor?*

Yes

11. Have you or any family member named above been diagnosed with a terminal condition?*

Yes

Traveler Medical Information

Important Notice for Travelers Aged 60 and Above.To ensure you receive the appropriate travel insurance coverage, you are required to complete the Medical Questionnaire form.

Instructions:

Download the Medical Questionnaire
- Click the button below to download the required Medical Questionnaire (PDF).
Complete and Sign the Form
- Fill in all the required medical details.
- Ensure the form is signed before submission.
Send the Completed Form
- Once completed, scan or take a clear photo of the signed document.
- Email the completed form to:
  📩 info@air1insurance.com
- Use the subject line: "Completed Medical Questionnaire – [Your Name]"

If you have any questions, please contact us at info@air1insurance.com for assistance.

Download Medical Questionnaire

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