Global Medical Insurance Coverage Letter Request

This request requires personal information.

If you are uncomfortable providing the information requested in this form, please contact University Risk Management at 205-934-5633 or email riskmanagement@uab.edu to submit your request.

Your Name*

Your Email Address*

Your Date of Birth*

This is required to issue the letter.

Country Requiring Proof of Coverage*

The letter will be country specific. If visiting more than one country, please complete additional request forms.

Dates of Travel*

Beginning and end dates that you will be traveling in the country listed above.

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