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System Information

Username *

Spaces are allowed; punctuation is not allowed except for periods, hyphens, apostrophes, and underscores.

E-mail address *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Password *

Confirm password *

Provide a password for the new account in both fields.

School/Plan *

Student ID *

Please enter your nine-digit Student ID number. Do not include letters. If your Student ID number is less than nine digits, please zero fill.

First Name *

Last Name *

Please note: Due to limitations in our database, your name may be shortened in your profile after registration. This ensures that it matches our records (maximum of 13 letters for a first name and 15 letters for a last name).

Date of Birth *

Month

Day

Year

Approve Terms and Conditions *

Terms and Conditions
The Campus Trust has taken the necessary measures to protect the confidentiality of the personal information you provide and to ensure that your electronic transactions with us are secure.
If you are using service on a shared computer in a public area (i.e. public kiosk or library), please ensure that you do not leave the computer unattended while accessing this service. This will ensure that no one else can access any personal information you may have entered. Ensure that you log out once you have completed your session so that none of your personal data is accessible to other individuals who will subsequently use the same computer. You must also be cautious about saving any personal information on the hard drive, which would also become accessible to other individuals. Also ensure to delete any outstanding print jobs when you conclude your session so that none of your personal information can subsequently be printed and be made available to other persons.

Member Authorization/Confirmation
I hereby confirm

that the information contained in this claim form is true and complete to the best of my knowledge.
that the persons for whom I am making a claim are eligible and that if the claim is being made on behalf of a dependent, I am authorized to disclose information about the dependent with respect to this claim.

On Behalf Of Myself and My Dependents:

I consent to the release of the information contained in this claim to The PBAS Group, its employees, agents, reinsurers, service providers and other organizations working with The PBAS Group for the purposes of underwriting, administration and processing of the claim.
I authorize any health care provider or professional, organization, insurance company, the policyholder, my student organization to disclose to The PBAS Group; its employees, agents and service providers any information regarding the treatment and expenses incurred which they may need in the assessment of the claim.
I understand and authorize that in the event there is reasonable suspicion of or any evidence of fraud or abuse regarding the claim, The PBAS Group will have the right to use and exchange any information related to the claim with any relevant regulatory, investigative or government body, any health care provider or professional medical organization, insurance company or reinsurer, the policy holder, student organization or any other party as provided by law for the purpose of investigating any such fraud or abuse.

I understand that personal information may be subject to disclosure to those authorized under the applicable laws within or outside of Canada.

Personal Information

Please provide your personal information here.

Address *

City *

Province *

Postal Code *

Security question

To reset your password in case you have forgotten it, a security question will be asked to verify your identity.

Question *

Choose the question that you would like asked.

Answer *

Type the answer to the question you have chosen.

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