Step 3 | Insurance Booking

You're applying for the following policy:
Provider:
Category:	Single
Policy Duration Start:
Policy Duration End:
Cost:	AUD $0.00

Select a Different Provider

Student Details

* Title

* Given Name

* Surname

* Date of Birth

* Gender

Male Female

* Home Country

* Passport number

Education Agent

The name of your education agent's company. Leave blank if you don't have an agent

Referral Code

The code of your education agent's company. Leave blank if you don't have an agent

* Street Address

Please write down your present Residental address

* Suburb

* State

* Postcode

* Country

* Policy start

Your policy must start from the date you'll arrive in Australia, or the date that any previous policy ends (or is cancelled).

* Policy end

Your policy must start from the date you'll arrive in Australia, or the date that any previous policy ends (or is cancelled).

* Education institution

The institution that you'll be studying at.

* Student ID

The ID Issued by the University .

* Coe start Date

Your must list down the start date listed in your COE

* Coe end Date

Your must list down the End date listed in your COE

* Mobile Number

* Email

* Email confirmation

We'll be sending your certificate by email, so make sure we've got the right one!

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Acceptance of Terms

I accept the Insurance Booking Terms and Conditions.

Declaration

I confirm that I will be the primary visa holder and I am eligible to apply for this policy.

Verifying sensitive Information

I confirm that all of the Sensitive information written above is correct and i would like to move forward with these informations.