Application Form - American University in Dubai

Mandatory Health Insurance Waiver
Private health insurance covering care in the U.A.E. is mandatory for all AUD students except U.A.E. Nationals. In order to
meet this requirement by enrolling in the AUD-sponsored health insurance plan, students are charged a non-refundable fee on their
Fall semester bill covering the period September 1 through August 31.
Fees and Charges for AUD Students Health Insurance Plan
Student joining beginning of
Fall Semester (covering September – August)
Spring Semester (covering January – August)
Summer I Semester (covering May – August)
Charges
AED1,800
AED1,200
AED700
For this fee to be waived, students are required to provide evidence of currently valid private health insurance
covering care in the U.A.E. (original insurance card or attached colored copy) to the Finance Office. Deadline to do so is
the last day of the Fall semester Drop/Add. Failure to provide this proof before the deadline will result in canceling your option to
waive the health insurance coverage and associated fee.
Do you have Health Insurance?
__No - the fee will be added to your tuition
__Yes - please fill below Form
To be filled by the Student
I understand that all students at AUD are required to have and maintain private health insurance covering all U.A.E. care on a
continual basis while enrolled.
__ I understand and agree that I am responsible for any and all charges related to my medical care.
__ I hereby certify that I have and will maintain current health insurance coverage while enrolled as a student at AUD.
_________________________________________________________________________________________________
Student Name
i.D.#
_______ - _______________________________________
Mobile #
_____________________________________________
E-mail Address
Enrollment Semester __Fall 20__ __Spring 20__ __Summer (1) 20__ __Summer(II) 20__
(Sept-Dec) (Jan-Apr) (May-Jun) (Jul-Aug)
_________________________________________________________________________________________________
Name of Insurance Company
Insurance Card Expiry Date _______ - _______ - _______
(mm/dd/yy)
_______________________________________________
Student Signature
_____________________________________________
date (mm/dd/yy)
To be filled by Finance Office
_______________________________________________
Finance Office Approval
_____________________________________________
Waiver Amount
This form is to be filled and processed through the Finance Office.
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