Student Study Abroad Travel Insurance Claim Form
Full Name
Date of Birth
Student ID
Passport Number
Email Address
Phone Number
Home University Name
Host University Name
Address Abroad
Insurance Policy Number
Insurance Provider
Travel Dates
Departure Date
Return Date
Type of Claim
Medical
Accident
Lost Luggage
Other
Date of Incident
Location of Incident
Description of Incident
Amount Claimed
Bank Details (for reimbursement)
Bank Name
Account Number
Account Holder Name
SWIFT/BIC
Signature
Date