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Insurance Request Form

Contact Details

(or Family Name)

Staff/Student *


Please note: Staff and Students must use their official University email account. Not using this may delay a response to your request.

Details of Request

Request type *


Attach or upload relevant documents (PDF, Word, Outlook or Zip Files only).

Please note: if you have more than three (3) documents that need to be uploaded, please create and upload all documents as a ZIP file.

Date required *

Please note:As a general rule, requests will be responded to within two (2) working days. More complex request may take longer than two (2) business days. If you require a response within a shorter timeframe, please outline the reasons for the urgency.


Please note: to ensure you receive the most appropriate advice, this request will be provided to the University's Insurance Broker. To read UC's privacy policy, go to Privacy at UC.