Complete form and attach membership card and evidence required

Holiday credit application

You must show a VALID OSHC Worldcare policy when you apply for Holiday Credit.

If your OSHC Worldcare policy expired during your absence, you must renew your cover

and backdate to the date of expiry before you can apply for your Holiday Credit.
You must be out of Australia for a period of 30 days or more.

You must apply for Holiday Credit within 30 days of your return to Australia.

PERSONAL AND POLICY DETAILS

Family Name________________________________________________________________________________________________________
Given Name:________________________________________________________________________________________________________
Date of Birth:________________________________________________________________________________________________________
OSHC Policy Number:_________________________________________________ Current policy expiry date:_ _____________________

AUSTRALIAN POSTAL ADDRESS

Street Number and Name:____________________________________________________________________________________________

Suburb:_ _________________________________________________ State:____________________________Postcode:_ _______________
Mobile Phone Number:_______________________________________________________________________________________________
Email address:_ _____________________________________________________________________________________________________

HOLIDAY CREDIT DETAILS

You will need to show or send photocopies of the identification page of your passport and the departure and arrival stamps in your passport.

Date of departure from Australia:_ _____________________________________________________________________________________

Date of arrival back into Australia:_ ____________________________________________________________________________________

OFFICE USE ONLY:

Date of application:______________________________ University staff member signature:_____________________________________

FAX: (07) 3305 7002

OR POST: OSHC Worldcare, Locked Bag 3001, Toowong QLD 4066

Privacy: The information that you provide is collected for the purpose of arranging a holiday credit of your OSHC Worldcare policy. The information may be disclosed to
educational providers the underwriter, government departments responsible for OSHC, medical practitioners, hospitals and other medical and assistance providers as required.
If you would like to gain access to your personal information please contact OSHC Worldcare.

OSHC Worldcare Mondial Assistance Locked Bag 3001, Toowong Queensland Australia 4066
Tel: in Australia 13 OSHC (13 67 42) From overseas: +61 7 3305 7000 Fax +61 7 3305 7009
ETI trading as OSHC Worldcare ABN 52 097 227 177 www.oshcworldcare.com.au oshc@worldcare.com.au

All plans are administered by OSHC Worldcare on behalf of Peoplecare.