Get a quote
Search
Am I eligible?
Members
Log In
Online Member Services
View and change your cover details, claims history, annual limits and more.
search
Members
Log In
Online Member Services
View and change your cover details, claims history, annual limits and more.
Get a quote
Student Declaration Form
Member First Name
*
Member Last Name
*
Member Email
*
Member Number
*
Dependant Name
*
Dependant Email
*
What year is your dependant studying in?
*
My dependant is
*
Studying full time
Not studying full time
Married or in a de facto relationship
Name of tertiary institution
*
*
I declare the the information I have provided to be true and correct.
Comments
This field is for validation purposes and should be left unchanged.
