How did you hear about us?* —Please choose an option—AdvertisementReferral / RecommendationSocial media (i.e. LinkedIn, Facebook)Website / Search engineWord of mouthOther source

Which province(s) are you licensed in?
OntarioQuebecBritish ColumbiaAlbertaManitobaSaskatchewanNova ScotiaNew BrunswickNewfoundland and LabradorPrince Edward IslandNorthwest TerritoriesNunavutYukon

Number of licensed agents in your company?*

Do Licensed agent(s) currently sell travel insurance?*
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What is the expected volume of sales (premium) for travel insurance within the next 12 months?*

Which products are you interested in selling?
Out-of-Province/Country medicalInternational studentsIndividual health plansVTC/Super visaExpatriate/in-patriate plans

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