Get Health Insurance Affidavit (pdf) - San Francisco State University

Filling out the Health Insurance Affidavit is an essential step for international students at San Francisco State University to document their health insurance coverage. This guide provides clear and systematic instructions to assist users in completing the form accurately online.

Follow the steps to complete the affidavit form online.

1. Click ‘Get Form’ button to access the Health Insurance Affidavit and open it in your preferred PDF editor.
2. Begin filling out the form by entering the insured person's last name, first name, and middle initial in the designated fields.
3. Provide the insured person's home country address and the address where they currently reside in the United States.
4. Fill in the home telephone number and email address of the insured individual for contact purposes.
5. Indicate the name of the insurance company that provides coverage and the effective dates of the policy. Be sure to include both the start and end dates.
6. Enter the policy number for the health insurance coverage and specify if it is an employment-based policy.
7. Sign the declaration at the bottom of the form confirming that the insurance policy meets the specified criteria. This includes coverage that is valid during the entire semester and meets the required medical benefits.
8. Once you have filled out all sections of the form, review it carefully to ensure all information is accurate and complete.
9. Save your changes and download the completed document. You can then print the form or share it as needed.

Complete your Health Insurance Affidavit online today to ensure your compliance with San Francisco State University's requirements.