Please complete the following form to register students for accident insurance.

Department Contact's Name:
Department Contact's Phone:
Department Contact's Email:
Upload Journal Voucher:
Account Number:

Below, list the students that you are registering for insurance:
Person Name: Student/Employee ID:

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Safety & Risk Services

Safety & Risk Services
Room 336 - 2389 Health Sciences Mall
Donald Rix Building (Technology Enterprise Facility III)
Vancouver, BC, V6T 1Z3
Tel: 604-822-2029
Fax: 604-822-6650
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