Once you have filled out the form above please mail or fax to:

Cowan Insurance Group
700-1420 Blair Towers Place, Ottawa ON K1J 9l8
Tel.: 1-888-509-7797 | Fax: 613-741-7771


*All claims must be reported to Cowan within 90 days of
occurrence.

* You are responsible for all fees charged for any supporting
documentation.

* Failure to complete and sign this form in its entirety or submit
supporting documentation will delay claim processing.

• Ensure you complete as much of the form as you can to avoid delays in processing. You must include your name, student ID number and contact information.

• Include the invoice or receipt from your medical appointment with your claim form.

• Include any medical notes, doctor notes, lab results or prescriptions to support your claim.

• If mailing your claim, please keep copies of all of your documents.