New Cases : 1 877 883-4598
Customer Service : 1 888 494-0650


Assurancia is represented in several cities of Quebec. We want to be involve in the different regions where we are represented. Assurancia encourage requests for sponsorship from organizations working for youth and children.

As Assurancia receives a large amount of support request, we ask you to kindly complete the attached form. This approach will allow a fair and expeditious processing of your application.

Fields in bold are required.

Describe the organization you are applying for financial support

Adresse :
Web site:
Phone number:
Non-profit organization: Yes No 
If yes, identification number:
Is your organization among our customers :  Yes No
Describe the nature of your request: 500 characters max.

We would like to have more information about the person making the request for sponsorship.

Last name:
First name:
Your address:
Phone number:
Email confirmation:
Are you currently an Assurancia Customer ?  Yes No
Who is your broker ?

Thank you for your interest in us. Be assured that your application will be reviewed carefully and we will respond as soon as possible.