ONLINE PURCHASE AGREEMENT

By submitting this Online Purchase Agreement, the Insured agree to the following:

1. Information Provided by Insured: All information provided in this application is true and complete. The
Insured has read and understood the terms of coverage of coverage, including the policy limitations and
exclusions, specifically the pre-existing conditions exclusion that applies and the emergency nature of this
coverage.
2. Medical Conditions: Coverage is issued based on the understanding that the Insured is not aware of any
medical conditions which may or may not require attention from a medical provider. If the Insured is unwell
or requires medical care at the time the policy is purchased, all claims submitted will be declined. The
Insured must refer to the Pre-existing exclusion clause as stated in the policy wording for this application.
3. Application: This application is a request only and not a guarantee of coverage. It is the Insured’s
responsibility to verify that the application has been received.
4. Paid Premium: An insurance application is only completed upon payment of full premium due. Coverage
is only effective when payment has been received.
5. Excursion: It is the Insured’s responsibility to be aware of the changing nature of the Government of
Canada’s Risk Assessments to travel a country for which the Canadian government has issued a travel
advisory to avoid all travel.
6. Personal Information: I hereby consent to the collection of the information requested on the application
form for use and disclosure of the personal information for the purposes of determining eligibility for
coverage under the policy and/or services purchased, assessing insurance risks, managing, and
adjudicating claims, negotiating or settling payments to third parties, as well as for providing counselling
services.
o We collect only the information we need for the purposes we have identified to you above.
o The information collected in the application process may be shared with your academic
institution for the purposes of ensuring adequate insurance for the study period.
o Our files are kept for the purpose of providing and servicing insurance products and services
that we believe are right for you. For more information, visit www.guard.me/privacy.

80 Allstate Parkway Tel: 905-752-6200 Fax: 905-752-6225 sales@guard.me

3rd Floor, Markham ON Toll-free: 1-877-873-8447 Toll-free: 1-866-329-8447 jesse@keepmesafe.org www.guard.me p a g e |1
Canada L3R 6H3

Travel Healthcare Insurance Solutions Inc. Underwritten by: Old Republic Insurance Company of Canada
ISO9001:2015 Registered