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View and change your cover details, claims history, annual limits and more.
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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.
*
Phone
This field is for validation purposes and should be left unchanged.
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