Health Insurance Report Form : Khon Kaen Unversity

Instruction

1. If this is first time of you to report please fill up the form below.

2. Please check your information as the link below.
>>Report Checklist<<

3. If your information doesn't show up please fill up the information again.

4. In case you would like to UPDATE information, please click this link.
>>Update Insurance Information<<

1. Student Information
Name*	Family Name*
Country*
Student ID Number*
Passport Number*
Faculty*
Major / Field of Study*
Level of Study*	or Other...
Student Status*	or Other...
Mobile Phone*	Email*
2. Emergency Contact Person
Name*	Family Name*
Relationship to Student*
Mobile Phone*	Email*
3. Health Insurance Information
Company Name*
Period of Insurance*	Issue Date* / / Expiry Date* / /
Remarks
Attachment : 1. Copy or Photo of Health Insurance Contract or Health Insurance Card (It must show issue date and expiry date)* jpeg only 2. Copy or Photo* of Passport* jpeg only 3. Copy or Photo* of Student ID Card jpeg only 4. Copy or Photo* of Other. jpeg only 5. Copy or Photo* of Other. *jpeg only