I (the Policyholder or Parent/Guardian) declare that:

1.        I am authorized by each person to complete this from and to sign it on his or her behalf.

2.        I am authorized by the credit cardholder to charge their credit card (if this is the payment method I have selected)

3.        All answer given above is complete, true and accurate. I have not withheld any information likely to affect the terms of acceptance of this application for cover. If I have not complete, true and accurate information, Southern Cross Benefits Limited may cancel my policy and refuse any claim I may make.

4.        My police contract is made up of my policy wording and my Certificate of Insurance. It is my responsibility to read and familiar with the policy wording. I acknowledge that my policy contains conditions and exclusions.

5.        I am not traveling with the intention of receiving medical treatment.

6.        I authorize Southern Cross Benefits Limited (which includes its representative, consultants and international assistance agent, Southern Cross Worldwide Assistance and re-insurer) to collect, hold and use information about the insured persons for the purposes of deciding to issue a policy, specific terms applying, investigating and verify claims and otherwise relating to matters covered by the policy terms. I authorize any doctor, hospital, clinic or other person to give Southern Cross Benefits Limited any and all information concerning my current and past medical history. A photocopy of this authorization shall be valid as the original. Each of the issued persons has the right to access and correct health and personal information held about them.

7.        Regarding the International Student Insurance policy, I understand that I may cancel this policy within 10 days of purchase provided that no claim have been submitted, and receive a full refund of the premium paid. I understand that after this period the policy will be non-refundable (except to the extent that your may be entitled to a refund under the Consumer Guarantees Act 1993)

8.        Regarding the Visiting New Zealand Insurance policy, I understand that I may cancel this policy within 3 days of the start date provided that no claim have been submitted, and receive a full refund of the premium paid. I understand that after this period the policy will be non-refundable

9.        I understand that I must inform Southern Cross Benefits Limited of any change of address, and that is my responsibility to ensure I renew my insurance without any lapse in cover.

10.    I understand that, if I have selected StudenEssentials as my plan then I have no cover under Section 8 – Baggage & Personal Items.

11.    I understand that the International Student Insurance policy is underwritten by Southern Cross Benefits Limited.

12.    I understand that the Visiting New Zealand Insurance policy is underwritten by Southern Cross Benefits Limited.