STUDENTSURE
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Send your application to us using the form below, or print this page and fax it to (604) 731 3137. To ensure that your application is processed as quickly as possible, please complete the application including all boxes marked with a *. A quotation will be sent to your email address within 24 hours. If you prefer a response by fax, please advise us of your fax number.

 Studentsure Health Plan - Individual Online Application

*Last Name *First Name
*Sex (M/F) *Age *Country of Origin
*Full Address in Canada
*Telephone number in Canada
*E-mail address *Visa Status
Visitor Student
School or Institution expected to attend
It is recommended that you begin your student insurance coverage from the date of your arrival in Canada.  Insurance coverage may begin thirty (30) days before classes start and extend up to fourteen (14) days after the end of classes.
Expected Date of Departure from Canada
*Start Date of Insurance *End Date of Insurance
Payment Options
Amount $
Cash Cheque: Payable to Winram Insurance
Visa Mastercard Debit
Card #  Expiry:
If you have any other questions or comments, please use the space provided below.  We will do our best to serve your needs!

This form constitutes an application for insurance coverage only and does not guarantee coverage. We are not responsible for lost or misdirected applications.

Winram Insurance will e-mail or fax a quotation within 48 hours, including payment instructions. Payment must be received by Winram Insurance before insurance can be effected.

Underwritten by The American Home Assurance Company, a wholly owned subsidiary of AIG. A brochure outlining the policy wording is available upon request. Benefits under this contract are subject to definitions, limitations and conditions as specified in the policy wording issued to the Policy Holder winram insurance

   
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This site provides only a brief summary of coverage and conditions.
Please refer to your actual policy wordings or contact a Studentsure professional.
Studentsure is part of the winram insurance family of insurance services.
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Phone: (604) 685-4288 E-mail:  info@winram.com