School Fees Insurance Policy 2007-08

INSURANCE FOR CONTINUATION OF STUDIES REQUEST FORM 2015-16
IMPRESO DE SOLICITUD DEL SEGURO DE CONTINUIDAD DE ESTUDIOS 2015-2016
Name of Pupil(s)
Nombre y apellidos del alumno(s)
_____________________________________________________________________________________
_____________________________________________________________________________________
Year Group
Curso
_____________________________________________________________________________________
_____________________________________________________________________________________
Email parent/legal tutor
E-mail del padre/madre/tutor
_____________________________________________________________________________________
_____________________________________________________________________________________

Yes, I would like to take out the Continuation of Studies Insurance. Please give details of
person or persons covered by the insurance.
Quisiera contratar el seguro de Continuidad de Estudios. Indíquense los datos de la persona o personas para las que se solicita cobertura.
Name and Surname of the 1º person insured
Nombre y apellidos del primer asegurado
___________________________________________________________________________
___________________________________________________________________________
Age___________________
Edad
NIF/NIE_________________________________________________
Name and Surname of the 2º person insured (optional)
Nombre y apellidos del segundo asegurado (opcional)
___________________________________________________________________________
___________________________________________________________________________
Age___________________
Edad
NIF/NIE__________________________________________________
Signature:
Firma
Date: ___
Fecha
/
2015