Application and Declaration Form
Personal Accident Insurance for Nominated Full Time Students - Kindergarten to Year 12 (ages 3 to 21 years).
Underwritten by AIG Australia Limited (AIG) ABN 93 004 727 753 AFSL 381686

For more information on StudentCover click here.

Instructions for Parents or Guardians:
As the Nominated Student listed in this Application your child will be insured anywhere in the world from the commencement date until 1st March of the following year.

The annual premium payable (inclusive of all charges) is $29.00 per student. The actual total premium charged depends on the date of application and will be displayed after completing the application.

StudentCover is only available by completing the following application and submitting it via this website. Payment will be required by credit card or debit card to finalise placement of the policy.

Once your application has been submitted you will receive an email containing your Insurance Certificate and Product Disclosure Statement. If you have paid by credit card or debit card you will also receive a receipt for your payment. These should be printed or saved to file for future reference. These are your policy documents.

Please complete the following details in full, some fields are compulsory.
We are committed to protecting your privacy. We use the information you provide to advise about and assist with your insurance and/or financial planning needs. We only provide your information to insurance companies, underwriting agencies, wholesale brokers and premium funders with whom you choose to deal (and their representatives). We do not trade, rent or sell your information. If you don't provide us with full information, we can't properly advise you and you could breach your duty of disclosure. You can check the information we hold about you at any time.
For more information about our Privacy Policy, ask us for a copy, visit our website or view here.

By completing the request below, I certify that I am aware that any collection of personal information is done so in accordance with EBM's Privacy Policy.
Purpose of Application:
School Details:
Your child's school is located in:
Student Details:
Student's Name:
Date of Birth:
Parent / Legal Guardian Name:
Postal Address:
Please provide at least one Telephone Number
Phone Number:
Mobile Number:
Email Address: