UHIP Cancellation Form

General Comment

This form is to be used by international students who have coverage under a UHIP Pre-Approved Health Care Plan.

Student information

Student Number *

First Name *

Last name *

uOttawa Email Address *

Please indicate your healthcare plan *

Specify, if 'Other'

Comments

Supporting document

Please make sure to upload the proof of your Pre-Approved Health Care Plan selected above:

Supporting document - Proof of your Pre-Approved Health Care Plan (Max file size: 2 Mb) *

Accepted formats : jpg, jpeg, png, doc, docx, pdf.Choose fileChosen file:

Please leave this field blank:

By submitting this form, you release uOttawa from any health coverage obligations. You also declare that you are aware that you will not be eligible for any services covered by UHIP during the period for which you have an exemption.