Enrol Short-term Study Plan (for Intermediaries) | StudySmart Overseas Student Insurance Plan | Travel Insurance | Individuals

Step 1 of 3: Plan enrollment

Fields added with (*) are mandatory.

Account no. *

Agent name *

Start date of travel *

End date of travel *

Both days included, maximum period of insurance is 6 months. For example, 01-01-2021 to 06-30-2021.

Please click here to view the premium table for the plan.

Step 2 of 3: Proposer’s and insured person's information

Fields added with (*) are mandatory.

Proposer's information

Title * Mr Mrs Ms

Surname *

First name *

HKID card no. *

Date of birth *

Sex * Male Female

Correspondence address

Flat, Floor, Block *

Building/ Estate, Street *

District, Region *

Mobile phone no. *

Day time telephone no.

Email address *

Insured person's information

Surname *

First name *

Other name

Sex * Male Female

Relationship with proposer *

Please select a identity document for input * HKID card Passport

HKID card / Passport no. *

Date of birth *

Step 3 of 3: Premium payment

Fields added with (*) are mandatory.

Payment method * Visa Mastercard

Credit card cardholder’s name *

Credit card no. *

Credit card expiry date *

If credit cardholder is not the proposer, please fill in the following information.

Credit cardholder relationship with the proposer

The cardholder hereby authorizes Zurich Insurance Company Ltd to charge automatically the premium due from his / her credit card stated above including subsequent premium payment for renewal of this policy and accepts full responsibility for any overdraft on his / her credit card which arises as a result of such transfer. For the continuation of coverage, the cardholder understands that he / she should arrange sufficient credit balance in his / her credit card by the premium due date for the automatic debit of premium.

Please check to indicate that you agree to the following statement: *

I/We further confirm my/our agreement to all sections in this enrollment form, including but without limitation to, the Declaration and the Notice to Customers relating to the Personal Data (Privacy) Ordinance.

Enrol StudySmart Overseas Student Insurance Plan – Short-term (for Intermediaries)

Step 1 of 3: Plan enrollment

Step 2 of 3: Proposer’s and insured person's information

Proposer's information

Insured person's information

Step 3 of 3: Premium payment

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