All

Customer Details

Specsavers Studentsafe Inbound Pre-approval Request Form

* Please bring photo ID when attending Specsavers so that your identification can be verified

Policy Holder and Individual Pre Approval Request

Course Type *

Multi Year/Returning Student

12 Month

Part Year/Short Course

Policy holder *

Please enter full name as per passport

Student visa expiry date

Date of Birth *

Studentsafe inbound policy *

Family / Couple Pre Approval Request

Only complete this section if you have paid for family cover and your spouse or child listed on the policy require the optical benefit

Name

Please enter full name as per passport

Relationship

Date of Birth

Phone

Appointment Details

Specsavers Store *

Nature of Claim

Claim Type *

Lost or Stolen

Damage

Change of Vision

Please provide a small description of nature of claim *

If stolen include police report ID. If damaged bring the damaged product to Specsavers for assessment

For Studentsafe Optical Benefit and Privacy Notice information please refer to your policy

Please contact the InsurancesafeNZ Team on 0800 486 004 (toll-free) or +64 9 488 1638 for support, or claimsadmin@allianzassistance.co.nz

Leave this field blank