FIRST COLUMN First Name: * Last Name: * Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year SECOND COLUMN Student Number * E-mail Address * Travel Underwriters' Policy Number * THIRD COLUMN Alternative Coverage from: * - Select -BC MEDICAL SERVICES PLAN (BC MSP)SCIENCE WITHOUT BORDERSSAUDI ARABIAN CULTURAL BUREAU-GWL FOR THE PLAN YOU HAVE INDICATED YOU MUST PROVIDE PROOF OF ALTERNATIVE COVERAGE (PDF, JPG, GIF OR PNG FILES ALLOWED). ACCEPTABLE PROOF INCLUDES ONE OF THE FOLLOWING: BC SERVICE CARD, OR CONFIRMATION OF COVERAGE FROM HEALTH INSURANCE BC, OR BC MSP INVOICE FROM REVENUE SERVICES. Proof of Coverage * Checkbox * The applicant confirms that they are covered by an alternate approved source of Student Medical Insurance and that the Kwantlen mandatory Medical Insurance is not required. CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.