Gold Plan

Fill out the form below to purchase your Gold Plan today!

PLEASE NOTE THAT GOLD PLAN COVERAGE IS NOT AVAILABLE FOR NOVA SCOTIA COMMUNITY COLLEGE STUDENTS OR NOVA SCOTIA INTERNATIONAL STUDENTS.

Please note that your payment of the premium is managed by Stripe. The Stripe process does not transmit further personal or financial information to SIP and your information is subject to Stripe's privacy policy.

Stripe protects your financial information with security and fraud prevention systems. When you use Stripe, your financial information is not shared with the merchant. Once your payment is complete, you will be emailed a receipt from Stripe for this transaction.

Please note if you do not receive an email receipt from Stripe, you do not have coverage.

Parent/Guardian Information:

NAME OF APPLICANT (PARENT OR GUARDIAN)

EMAIL ADDRESS

ADDRESS

POSTAL CODE

DAYTIME PHONE

Student Information:

LAST NAME

FIRST NAME

INITIALS

DATE OF BIRTH

NAME OF REGIONAL CENTRE FOR EDUCATION OR CONSEIL SCOLAIRE ACADIEN PROVINCIAL (NOT AVAILABLE FOR NSCC)

NAME OF SCHOOL(S) (NOT AVAILABLE FOR NSCC)

Add Student

Please Note: Plans are based on how many students are covered

Plan 1

$14.00 (1 Student)

Plan 2

$28.00 (2 Students)

Plan 3

$35.00 (3+ Students)

Payment Summary

SubTotal: [[Cms_SubTotal]]

Tax: [[Cms_Tax]]

Total: [[Cms_Total]]

Credit Card

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