21 Century: Monthly Plan for Super Visa Activation Form

Activate your Monthly Super Visa Insurance plan

Your personal information is secure with us. We do not provide it to third parties.

In case you purchased your Super Visa Insurance on a monthly basis, your policy is pending until you request activation. Just fill out the application form below at least 2 or 3 days before your policy starts (arrival date), and we will take care of this for you!

Policy Number*

Policy Holder Name*

Activation Date (Date of arrival)*

Your information

Please enter details of the person requesting activation

Full Name*

Your e-mail*

Phone number in Canada*

Failure to activate the policy prior to arrival may result in waiting period of up to 7 days, loss of coverage, and repatriation to home country. It is very important to have a valid policy at all times during the visit to Canada to avoid unexpected losses.

Please, fill out the form above to request an activation for your 21 Century: Monthly Plan activation. Note that you will be unable to make claims, if your plans is pending activation.

21 Century: Monthly Plan for Super Visa Activation Form

Activate your Monthly Super Visa Insurance plan

Please, fill out the form above to request an activation for your 21 Century: Monthly Plan activation. Note that you will be unable to make claims, if your plans is pending activation.

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For Canadian Residents

For Visitors to Canada