Application for Travel Insurance
To:
Mr Herman Codner
Assistant Treasury Accountant
Room 8.20
James Clerk Maxwell Building
57 Waterloo Road
London
SE1 8WA
From:
Name:
(Dr / Ms / Mr / Prof)
Department
Address
Site
Destination
Reason for Travel
Period of Travel:
From
to
I hereby certify that the above student is travelling abroad in connection with College
studies, and would ask for the necessary travel cover to be arranged.
Signed:
(First supervisor)
Date:
(Head of Department)