VTC – MHQ

Primary Applicant

First Name

Last Name

Date of Birth

Gender

Female

Male

Canadian phone number

Home Country

Eligibility

You must meet the following eligibility requirements on the departure date of each trip in order to be eligible for coverage.

Coverage is NOT AVAILABLE if, on departure date, you:

Are travelling against the advice of a physician;
Have been diagnosed with or been given a life expectancy of 6 months or less;
Have been prescribed and/or used home oxygen within the past 24 months
Have been prescribed or recommended the use of dialysis in the last 12 months;
Are under 15 days old, or are age 89 years or older;
Reside in a nursing home, home for the aged, other long-term care facility or rehabilitation center; or
Require assistance with activities of daily living.
Are awaiting or received an organ transplant
Have ever had any cancer with metastasis (which includes positive lymph nodes), or undergone chemotherapy (of any form, except cream) in the last 6 months
Have been diagnosed with or treated for Congestive Heart Failure

Are you eligible?

Yes

No

Rate Qualification

Would you like to cover Pre-existing medical conditions?

Yes

No

Is this policy for a Super Visa?

Yes

No

Choose coverage:

$25,000

$50,000

$100,000

$150,000

$300,000

TrueNorth Visitor Plan