Easy Steps to Get F1-OPT Insurance

f1-opt insurance

Student Personal Information

Name

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Email Id

Please enter a valid email-Id

Phone Number

Phone

Please enter a valid phone number

Gender

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Date of Birth

Your University

Travel Information

Currently in India?

Travel Date

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Coverage Start Date

Coverage End Date

Coverage Period

Other Information

Student's Pan Number

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Sponsor Name

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Emergency Contact Number

Phone

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Alternate Email Id

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Mother’s Name

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Student's Passport Number

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Nominee's Name

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Nominee Relation

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Nominee DOB

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Address In India

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Health Declaration

I have left India as on , and I request you to issue me a policy effective as soon as possible, since post my travel from India there have been no contingencies/medical events & emergencies reported by me till date. Also I do not anticipate any medical situation in the policy period from to which can lead in claim and hereby declare that I am in a sound physical and mental health at the time of the purchase of this policy.

The reason, I could not purchase the insurance before traveling as I was busy with my travel preparations and exams.

Name:

Date: 30-09-2024

Nominee Details

Name:

DOB:

Relation:

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