Visitors to Canada Application Form

Out of Canada Application Form

Please fax application forms to 905-480-9939 or give us a call for orders.

Ready With:

• Insured’s name
• Date of birth
• Date of entry to Canada
• Country of Origin
• Status in Canada, such as: visitors, New Immigrants, Return Canadian, Student/Work Permit, etc
• Contact person / sponsor’s name, address and contact telephone number
• Cover amount and Coverage period

Pay the premium:

• By VisaCard or MasterCard
• By direct deposit into any TD Canada Trust branch, our account No. 233-5206192, and fax/mail back the deposit receipt to Fok’s Insurance Agency
• The insurance premium you paid is inclusive of a standard commission that 21st Century Travel Insurance Ltd. or TIC Travel Insurance Coordinators Ltd. allows us.

Call 905-480-9993
or 416-229-9076
or 1-800-811-9988
Email: admin@fok.ca
Fax: 905-480-9939