THE UNIVERSITY OF ESSEX’S TRAVEL/MEDICAL INSURANCE POLICY
For European Destinations
EACH STUDENT IS REQUIRED TO COMPLETE AND SUBMIT THIS FORM TO ESSEX ABROAD BY 31 May
2016 – late applications for insurance cannot be accepted.
(Please put X in the appropriate box)
I confirm that I have a valid EHIC card (European Health Insurance Card)
http://www.nhs.uk/chq/pages/1073.aspx?categoryid=68&subcategoryid=159
I wish to take out the University of Essex cover for one year in Europe
(Sept to June) (£0.95 x 304 days)
£288.80
I confirm that I do not wish to accept the Travel / Medical Insurance cover offered by
the University of Essex and that I shall make my own alternative arrangements.
The Erasmus Mobility Contract requires students to have adequate insurance cover.
I understand that if I do not make any alternative arrangements that I am assuming the
risk myself and would not seek any payment or compensation from the University
under the cover provided by the University Travel / Medical Insurance policy.
MY DEPARTURE DATE FROM THE UK WILL BE:
DATE/MONTH/YEAR
NAME OF STUDENT
(BLOCK CAPITALS)
SIGNATURE
DATE
AN INVOICE FOR THE REQUIRED PAYMENT WILL BE ADDED TO YOUR ESSEX STUDENT FINANCE ACCOUNT AREA
AND WILL NEED TO BE SETTLED BEFORE THE COVER IS ACTIVATED.