Please complete and return within 30 days from the opening day of school to:
A.W.G. Dewar, Inc., Four Batterymarch Park, Quincy, MA 02169-7468
 
 
Attached to and forming part of Policy No.
 
Name of School/College*
 
Address*
 
  
City* 		  
State*
Zip Code*
   
  THE FOLLOWING DETAILS ARE IMPORTANT - PLEASE COMPLETE THIS SECTION
  Classes Commence* Select Date Last Day of Final Exams* Select Date
  Total Number of Days
(Exclude Orientation, Registration Days, Early Sports Practice and Graduation)
   
 
Winter Vacation From* Select Date To* Select Date
Spring Vacation From* Select Date To* Select Date
  Number of Day Students*
  Number of Resident Students*
  Total Enrollment*
  *Indicates a required field
   
  If you would like to attach your complete list of insured students under the Tuition
Refund Plan, please complete the information above and attach your file.
  Attach a List of Insured Students
  Attach a Second List of Insured Students (if necessary)
 
 
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