Get Form Rm23 - Purdue University - Purdue

Filling out the Form RM23 is essential for securing international medical and evacuation insurance for university travel. This guide will provide clear, step-by-step instructions to assist users in completing the form accurately and efficiently.

Follow the steps to fill out the Form RM23 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the 'Date of Request' section, enter the date you are submitting the form. This helps in tracking your submission.
3. Fill in the 'Prepared By' section with your name. Be sure to provide accurate spelling.
4. Indicate where to send ID cards by providing the recipient's name, phone number, department name, and the building or department name.
5. In the 'Program Name' section, specify the name of the program related to your travel.
6. Enter the destination details under 'Destination', providing the city and country where you will be traveling.
7. In the 'Coverage to be Effective' section, input the start and end dates for your insurance coverage.
8. Answer the question regarding travel warnings from the U.S. Department of State by selecting 'Yes' or 'No'. If 'Yes', you must seek approval from the Dean of International Programs and obtain their signature.
9. Specify the 'Fund to Charge' and 'Cost Center' relevant to your trip.
10. List the participants to be covered by the insurance by providing their names, PUID numbers, and dates of birth.
11. Review all the information provided to ensure accuracy and completeness.
12. Fax the completed form to Risk Management at 765-494-1338 or 765-496-1338. Remember, the form must be submitted two weeks prior to the start of your trip.
13. After filling out the necessary sections, you can save changes, download, print, or share the form as needed.

Complete your documents online to ensure a smooth travel experience.