Forms - Fok's Insurance Agency, Sam Fok, Toronto, Canada

Fok's Insurance Agency
(A Division of 1216251 Ontario Inc.)

"Our Service Starts with HONESTY, Maintains with INTEGRITY."

Sam Fok
Sam Fok
MBA, M.Div., CLU, CFP, RIB.
Chartered Life Underwriter
Chartered Financial Planner
Registered Insurance Broker

MAJOR Services

New Immigrants & Visitors Medical Insurance.

Life & Critical
Illness Insurance

Out-Of-Province
Travel Insurance

Frequently Asked Questions

Want to buy Now!!

Please call us at:

905-480-9993
416-229-9076
1-800-811-9988

or E-mail us at
admin@fok.ca

Query / Comment?

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Forms -> 21st Century Medical Insurance Plan / TIC Insurance Plan

Please view / download the following Forms in PDF format:
(Acrobat Reader required, you may download the lastest version from here.)

For 21st Century Insurance Plan (Visitors/New Immigrants-to-Canada)

Forms

Claim Form & Attending Physician’s Statement
Medical Declaration
Special Consideration Form
Premium Rate Tables (Effective June 15, 2009)

Form Letters

For TIC Insurance Plan (Visitors-to-Canada & Out-of-Country Travel Insurance)

Forms

Medical Certificate - Out of Canada
Claim Form - Out of Canada: page 1, page 2
Claim Form - Visitors to Canada: page 1, page 2
Authorization & Release – OHIP
Refund Request Form (Claim Waiver)
Claim Form and the attending physician/dentist statement - Visitors to Canada

For help in using the Forms, please call us at

905-480-9993
Toronto Line: 416-229-9076
Toll Free: 1-800-811-9988.

Want to Buy Now!!