Specsavers Studentsafe Pre-approval Request Form

 
 
Policy Holder and Individual Pre Approval Request *
 

Student Id*:   

 

Course Type*:   

Multi Year/Returning Student    12 Month    Part Year/Short Course

Policy Holder*:   

please enter FULL name as per passport

Address*:  

 

Student visa expiry date:   

Date of Birth*:   

 

Email address*:   

Telephone number business hours*:   

 

Studentsafe inbound policy*:   

Education Provider*:   

 
 
 
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:   

Email address:   

Telephone number business hours:   

 
 
  
 
Appointment Details *
 

Specsavers Store*:   

Product*:   

 
  
 
Nature of Claim *
 
 
*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)   

 
 

Find a Specsavers Store here...
For Studentsafe Optical Benefit and Privacy Notice information please refer to your policy

 

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