Dependent Student Registration Please fill out the form below Status: My child is a full-time student, and I will complete the form below.My child is not a student, but I would still like to discuss the options to keep them on a family policy. I will fill in my details to receive a call back. This option is available on selected covers.My child is no longer a student and can take their own cover. I will fill in their details so they will receive a call back. Confirm your child's dependent student registration Please complete this form so we’re able to update your membership. If we don’t hear from you, we’ll assume your child is not a student and they will be removed from your family’s health cover. Unfortunately, this means they’ll no longer be covered by Transport Health and they may need to re-serve waiting periods again on rejoining. Main member's details (this is the person in whose name the cover is held) Given Name * : Family Name * : Date of Birth * : Calendar DD/MM/YYYY Member date of birth If your dependant is being removed from your membership, we can help! We’d love to talk with them about setting up their own membership to start their private health cover journey with Transport Health. By filling in their details below, you’re consenting to Rt Health contacting them to discuss private health cover. Membership Number * : Best contact phone number: ( ) - Second three digits Last four digits Email Address: Dependent student details Student Given Name: Student Family Name: Student date of birth: Calendar DD/MM/YYYY Student date of birth Best contact phone number: ( ) - Second three digits Last four digits Email Address: Contact Number: ( ) - Second three digits Last four digits Your child is eligible to remain covered as a dependent student This registration will remain in place until 28 February 2024. We will contact you before this date to confirm that your child is still eligible to be covered as a dependent student. Name of school / college / university being attended: Is your child due to complete their course of study this year or cease being a full-time student this year: Yes No What is the expected date of completion or ceasing full-time study: Calendar DD/MM/YYYY Would you like your child to receive their own Transport Health membership card: Yes No Would you like your child to sign claims on their own behalf: Yes No If yes, you are authorising your child to make claims on the membership without the need for your signature. Declaration I understand that if my child leaves full-time study, or becomes Married/de facto, he/she will no longer be eligible to remain covered as a dependant student. I understand that Transport Health reserves the right to verify my child’s eligibility for cover as a dependant student. I will notify Transport Health fund if there is any change in my child’s circumstances that affects his/her eligibility to remain covered immediately. I confirm that my son/daughter meets the student criteria which is: between 21 and 25 years of age (inclusive); a full-time student at school, college or university in Australia; unmarried and not in a de facto relationship; primarily reliant on the Principal Member or their Partner (listed on the Policy) for maintenance and support; and related to the Principal Member or their Partner as a child, step-child, foster child or other child that the Principal Member or their Partner has legal guardianship over. Please note, part-time students and apprentices are not eligible for cover as dependant students. Please also note that if at any time the eligibility as a dependant student ceases you need to contact us to make other arrangements if continuing health cover is required. Please also note that cover for a dependent student will cease from the date they ceased to be eligible and no claims by them will be covered from that time unless you have made new arrangements to cover them under an extended policy. I've read and agree to the above terms and conditions and confirm the information I've provided is correct.