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Health Insurance Form - ETFS

 Application for Health Insurance - ETFS

Academic Year 2010-2011 (Sept. 1, 2010 to August 31, 2011)

Identification


                                          (DD/MM/YYYY)

Period of Coverage

I am buying health insurance with ETFS for the full duration of my stay in 2010-2011:

   4 months: $262.40         8 months: $524.80        12 months: $787.20

 

Method of Payment Accepted

Cash or Interac:   In person at our counter (McGreer Bldg 1st floor)

Cheque:                  Make your cheque payable to: Bishop’s University
                                  Indicate your ID number on your cheque

BankTransfer:       You must contact our office and once you identify yourself, we will be able to provide our banking information for direct bank transfer.