TRAVEL INSURANCE

Do NOT include SIN or any account numbers.
Please complete the form below so we can prepare an accurate travel insurance quote for you and/or your family.

Full Name *

Date of Birth *

Email *

Mobile Number *

City & Province of Residence *

Preferred Languange *

English

Français

Both / Either

Type of Traveler *

Single traveler

Couple

Family

Group

Country of Origin:

Destination(s) *

Example: USA, Philippines, Europe, Mexico, Worldwide

Purpose of Travel *

Vacation / leisure

Visiting family

Business trip

School / study

Other

Travel Start Date (Departure) *

Travel End Date (Return) *

Are you currently outside your home province/country? *

Yes

Will you include additional travelers? *

Yes

If YES, list FULL NAME + DATE OF BIRTH for each traveler:

Example: Spouse – Jane Doe — 1988-02-17 Child – Jacob Doe — 2015-08-06 Child – Kyler Doe — 2018-11-23

What kind of travel coverage do you need? (Select all that apply) *

Emergency Medical Coverage

COVID-19 Protection

Trip Cancellation

Trip Interruption

Baggage Loss & Delay

All-inclusive package

Not sure — help me choose

Do you need coverage for multiple trips this year (Annual Multi-Trip Plan)?

Yes

Not sure

Have you been diagnosed with any medical condition in the last 12 months? *

Yes

If YES, provide details:

Option 1
Option 2
Option 3
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List is empty.

Are you currently taking any prescription medications? *

Yes

Prefer not to say

If YES, please list medications (optional):

Option 1
Option 2
Option 3
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List is empty.

Do you require a pre-existing condition stability clause?

Yes

Not sure / please explain

Are you pregnant? (if applicable)

Yes

Not applicable

Preferred Consultation Method:

Zoom / video call

In-person

Consent to be contacted
I agree that a representative from JK Infinite Solutions may contact me by phone, email, or text message to discuss my financial needs and potential solutions.

CASL / marketing consent
I would like to receive educational content, invitations to webinars, and updates about financial strategies and services. I understand I can unsubscribe at any time.

This form collects basic information needed to provide a travel insurance quote. All applications are subject to underwriting approval, medical eligibility rules, and provincial regulations. Please do not include SIN or sensitive data.