Students Insurance
Student Plan Type
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International student studying in Canada
Canadian student studying outside Canada
Full Name
*
Phone Number
*
Email Address
*
Age of the Student
*
Number of Accompanying Dependents (spouse and children)
*
Canadian Province or Territory
*
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
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Start Date
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End Date
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Student Type
*
Full Time
Part Time
Post-Doctorial Research
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