OSHC application form - nib
OSHC application form - nib
OSHC application form - nib
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OFFICE USE ONLYDate of joining this policyAPPLYING ISAS EASY AS...Rep codeFRANC IDSource code(s)<strong>nib</strong> office note12APPLICATION FOR <strong>nib</strong> <strong>OSHC</strong>To apply for <strong>nib</strong> <strong>OSHC</strong> you must complete section 1This section contains in<strong>form</strong>ation regarding your personaldetails. If you or any person listed in this <strong>application</strong> aretransferring from another health fund, please ensure that aseparate Clearance/Cancellation Certificate is completedfor each health fund.For additional Clearance/Cancellation Certificates, contact<strong>nib</strong> on 1800 775 204.PAYMENT OPTIONSComplete this section by selecting the payment methodfor your premiums.customer care centre1800 775 204mon-fri 8am-8.30pm sat 8am-1pm (AEST)or visit<strong>nib</strong>.com.au/oshcApplication<strong>form</strong><strong>OSHC</strong>Overseas Student Health Cover3DECLARATIONPlease read the declaration and acknowledge youracceptance by signing and dating the signature panel.Once completed, send your <strong>nib</strong> <strong>application</strong> <strong>form</strong> to:<strong>nib</strong> health funds,Reply Paid 62208Newcastle NSW 2300(no postage stamp required)Or you can visit any <strong>nib</strong> Retail Centre.<strong>nib</strong> health funds limited abn 83 000 124 381Head Office 22 Honeysuckle Drive Newcastle NSW 2300<strong>nib</strong>254613_1113
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