Online Application
Step 1 of 3: Enter Insured Information
Include all family members to be insured on this form.
Manitoba
students and parents please refer to
Manitoba Student Accident Insurance
for a description of plans and benefits for Manitoba.
Click here to view plan details.
Where did you hear about insuremykids®?
Child's School
IMK Brochure
Email from IMK
Word of Mouth
Facebook
Twitter
Google Search
Direct Mail
(optional)
Please Specify:
Start Date :
(dd-mm-yyyy)
Province
School Board
Multi-year Option
Alberta
British Columbia
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Saskatchewan
Yukon
choose school board ...
1 year
3 years
5 years
The 3 and 5 year rates can save you 5% and 10% respectively.
Date of Birth
First Name
Last Name
YYYY
MM
DD
School Name
Plan
view plans
Optional Coverage
choose school ...
(Other)
choose plan ...
Platinum Plan
Gold Plan
Silver Plan
remove
choose school ...
(Other)
choose plan ...
Platinum Plan
Gold Plan
Silver Plan
remove
choose school ...
(Other)
choose plan ...
Platinum Plan
Gold Plan
Silver Plan
remove
choose school ...
(Other)
choose plan ...
Platinum Plan
Gold Plan
Silver Plan
remove
choose school ...
(Other)
choose plan ...
Platinum Plan
Gold Plan
Silver Plan
remove
Need space to add more family members? Click here.
English
|
Français
Copyright © 2009 - 2024 Old Republic Insurance Company of Canada / Tous droits réservés 2009 - 2024 © Old Republic, Compagnie d'assurance du Canada.