Health Insurance Registration Form
Health Insurance cover for students applying to UK Ireland and Australia
Student Name
First Name
Last Name
Student Address
Student Date of Birth
Enter Date of Birth written in student passport
Student CNIC#
Student Passport#
Passport#
Mention passport # of student
Email ID of Student
Enter student Email ID to receive insurance at this email address
Student Phone#
-
Area Code
Phone Number
Next to Kin / Sponsor Name
Relationship with Sponsor
Office/Agent
Head Office LHR
Islamabad
Karachi
Peshawar
Sialkot
Gujranwala
Others
I you have paid PKR to any SCS Office please mention which office?
College/University student applied for
Mention name of Institution. Eg Griffith University Australia
Name of course
For example: MBA
Actual Insurance Cost
Eg. 120 Euro, GBP 600 etc.
Student paid in PKR
Mention actual amount student / agent paid to SCS for this policy
How student / Office paid to SCS
Cash
Bank Transfer- Mention Bank Name
Credit Card
Adjustment
Other
Mention if you paid via Bank deposit or else.
Mode Of Payment
Cash at office
Online in Bank
Adjustments
Other
SCS Bank used for payment
SCS Standard Ch Bank
SCS Faysal Bank
Other Bank
Course Start date
Course end Date
Cost of Course
Do you want COVID Cover (COVID cover policy will cost extra)
Yes
No
For Office Use only
SCS staff will enter below details. Agent / Student leave these blank when ordering policy
Insurance policy#
Once issued SCS staff will enter Policy#
Upload payment receipt
Browse Files
Upload receipt of student payment
Cancel
of
Upload Insurance policy
Browse Files
Once issued SCS staff will upload policy doc
Cancel
of
Student Visa Current Status
will apply
Applied
Approved
Refused
Appeal
Other
Once visa decision arrive SCS staff will enter here
Office Remarks
Submit
Should be Empty: