University of Brighton Document1
Insurance Notification of Student(s) Making a Visit Abroad
(Please refer to the ‘Travel Guidance/Frequently Asked Questions’ overleaf)
First Name Last Name
Nature of Visit Complementary Placement Is this Trip of an Unusual or
Yes ( ) No ( )
in full, including
the country you
will be visiting)
Our Insurer follows the guidelines set by the Foreign Office on their website (www.fco.gov.uk). Where the Foreign
Office advises against travel to a country/region then travel cover is not available.
Date of Departure Date of Return
Total Number of Days Abroad (both dates inclusive)
Signature of Visit
Note for Visit Organiser(s) – if this is a group visit then it is not necessary for each traveller to
have an emergency card. All group organiser(s) should complete their own travel notification
forms and obtain an emergency card before travelling.
I CONFIRM THAT THIS TRIP COMPLIES WITH THE UNIVERSITY CODE OF PRACTICE ON
OVERSEAS TRAVEL (AVAILABLE ON THE HEALTH AND SAFETY DEPARTMENT WEBSITE).
PLEASE CONTACT THE HEALTH AND SAFETY DEPARTMENT ON 01273 643144 FOR FURTHER
Please submit this completed form with the ‘Authority to Start Placement’ form (CP2) to the
Partnership Office (room A208), School of Education, University of Brighton, Falmer site,
Brighton. BN1 9PH at least one week prior to date of departure.
NEED AN EMERGENCY CARD? THEN PLEASE TICK HERE ( ) AND REMEMBER TO ENCLOSE
DETAILS OF WHERE YOU WOULD LIKE IT SENT.
University of Brighton Document1
TRAVEL GUIDANCE/FREQUENTLY ASKED QUESTIONS
1. Where do I need to send my completed form, and where can I get an emergency card?
Please submit the completed form together with form CP2 to the Partnership Office (room A208), School of
Education, at least one week prior to the date of departure. You can obtain an emergency card from the Insurance
Officer, Finance Department, on Ext. 2726. If you are travelling as part of a group then your group leader’s card
will also cover you. Once obtained, cards may be used for further travel provided a new form is completed on each
IMPORTANT: AIG Europe emergency cards issued prior to 1 August 2004 are NO LONGER VALID
3. What exactly am I covered for, and are there any territory restrictions?
Please refer to the Policy terms & conditions which are available for inspection on the Staff Intranet (UoB
Intranet>Administration>Finance>Travel Insurance> Summary of Cover).
N.B. Please note our Insurer follows the guidelines set by the Foreign Office on their website (www.fco.gov.uk).
Where the Foreign Office advises against travel to a country/region then travel cover is not available. YOU
MUST NOT TRAVEL TO THOSE COUNTRIES WHERE TRAVEL INSURANCE HAS BEEN EXCLUDED.
It is your responsibility to check this list before your trip is finalised and any travel arrangements are made.
4. What do I need to do if I am taken ill or injured while abroad?
If a medical emergency occurs, then please use your emergency card to contact a representative of Inter Partner
Assistance who will help you. If the card has been mislaid the Inter Partner Assistance telephone number is:
++44 845 271 3848. You will need to supply the following information:
Insurance Policy Number – NHE-17CA04-0043(Zurich Municipal)
Name of Patient
Location of Patient
Type of Assistance Required
Where appropriate, they can arrange payment of Medical fees. In cases where this is not possible and you are
unable to settle the bill yourself or you require reimbursement whilst abroad, then you will have to submit a claim
via the University’s Insurance Officer.
To obtain a claim form please call +44 1273 642726 or Fax +44 1273 642741 or by email to
C.W.Bench@brighton.ac.uk or firstname.lastname@example.org
The following must be provided, and no money can be sent until the University Insurers approve your claim:
Copies of appropriate receipts, letter from Hospital/Doctor/Clinic.
Full contact details (Full address, telephone/fax and email address if applicable). If this is not provided your
payment may be delayed.
A completed claim form.
This service is for EMERGENCY MEDICAL ASSISTANCE ONLY.
If your illness is: (a) of a less serious nature; b) you do not require hospital treatment; (c) your stay abroad is for
less than a month, then please settle any bills for treatment/medication yourself, and upon return to the UK submit a
formal claim (see below). Travel claims take on average 4-5 weeks to settle from the date a completed claim form is
sent to the Insurer.
Thefts must be reported to the local police immediately and a signed/stamped police report should be obtained.
5. How do I submit a claim once I’ve returned to the UK?
Please notify the Insurance Officer who will be able to help you.
6. Who do I contact if I need further information about our Travel Insurance?
Please contact the Insurance Officer, Finance Department, on Ext. 2726, who will be glad to help you!
PLEASE TAKE THESE NOTES WITH YOU WHEN YOU TRAVEL