Annual Student Travel Insurance

Insurance Application & Credit Card Authorization Form

Apply Now with the Form Below

  • Please enter the payment information using the secure form below:

  • Date Format: DD slash MM slash YYYY
  • Date Format: YYYY dash MM dash DD
  • Date Format: DD slash MM slash YYYY
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  • $ 0.00 CAD
  • American Express
  • Terms and Conditions

    I understand that this plan does not cover a medical condition that existed prior to the effective date of the policy or any condition wholly or partly, directly or indirectly related thereto when the application for insurance is made more than 30 days after the date of arrival or departure to/from Canada. I authorize Lions Gate Underwriting and its authorized agents or representatives as my attorney to have access to all documentation required to complete my claim.

    1. Travel worldwide during the period of coverage is valid as long as the majority of the period of coverage is spent in Canada or country of study.
    2. Visits to your home country are permitted; your Policy will not terminate; however, expenses will not be covered while in your home country.
    3. When you are enrolled in a school, coverage will be provided during school breaks as long as your Policy is in effect during these periods
    4. Coverage commences upon arrival or departure date and applies for 365 days from that date provided the student is enrolled in school or until the Policy expiration date as stated on the policy, whichever comes first.
    5. This is an application of coverage only, subject to review and confirmation of coverage by Lions Gate Underwriting and receipt of policy documents.

    By signing and submitting this form, I agree that I have read, understand and agree with the above conditions. The credit card holder agrees to $1,070 CDN being charged for an annual student travel medical insurance policy. Upon receipt of payment confirmation of insurance coverage and a student travel card will be emailed to the email address included above.

  • Use your mouse to draw your signature in the box provided indicating your acceptance of the terms above.

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2636 Shaughnessy Street
Port Coquitlam, BC V3C 3G6