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Claim Form

For your convenience, we have posted a copy of our student insurance claim form on our Web site, which can be downloaded below. Please contact our office if you have any questions filling out the claim form.

Insurance Claim Form (PDF/36KB)

Completed claim forms should be mailed to the following address:
CLAIMS ADMINISTRATOR:
BOLLINGER INC.
P.O. Box 727
Short Hills, NJ 07078-0727