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E note: You may change your plan on-line at www.polmed.co.za. (You will need to log on as a member with your PIN to access this facility.) Alternatively, this form is available for printing from our website. Please complete all four sections on this form. Please Note: E Should you not return your Plan Selection Form by 31 December 2009, you will remain on the same plan. E Should you decide to remain on the same plan, you are still required to complete this form and return to the addr.

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