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Uni-Care International Travel Insurance Service
Crombie Lockwood (NZ) Limited
Box 32167 Devonport Auckland 0744, New Zealand
Tel: 64-9-446 1166 Fax: 64-9-445 8832
Email:


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APPLICATION FOR A MASTER POLICY NUMBER

The 15% premium retention that Uni-Care allows is stated in our policy document and on our brochures as being for Administration purposes.

To apply for a Master Policy number, complete the following application details which will be sent to us when the ACCEPT button below is activated.

1. Registered name of Educational Institution or agency

IMPORTANT A selection must be made from each of the following 4 drop down lists:

2. Type of organisation?  

3. Details of Instituton or Agency

(a) Name & title of authorised person  

(b) Postal Address  

(c) Telephone  

(d) Fax  

(e) Email  
Due to the huge difficulties in communicating with 'hanmail' and 'hotmail' accounts, a prerequisite to being issued with a Master Policy User Number is that you specify an alternative type of email address as the main point of contact.

4. Invoice to be sent to? (if different from authorised person)

(a) Name & title of accounts contact  

(b) Postal Address  

(c) Telephone  

(d) Fax  

(e) Email  
Due to the huge difficulties in communicating with 'hanmail' and 'hotmail' accounts, a prerequisite to being issued with a Master Policy User Number is that you specify an alternative type of email address as the main point of contact.

5. Number of applications expected each year  

6. Number of brochures required  

Agents please list education providers you are associated with


Click on this button only once. There may be several seconds delay before an acknowledgement appears. If you click twice we receive two application transmissions.