I understand that in order to be eligible for this individual study abroad insurance, all of the following statements about myself must be true:

• I am a permanent resident or citizen of the United States or a J-1, F-1 or M-1 visa holder in the USA going abroad with my US institution.
• I am a participant of a study abroad program and/or an international, educational, and cultural activity outside of the United States.
• I understand that medical expenses incurred in the United States are not covered by this plan.
• I understand that medical expense(s) for any condition(s), which existed within the twelve months prior to the coverage start date, will not be covered by this plan.
• I certify that the personal information, which I will provide on the application that follows, will be truthful and accurate.