Get Momentum Health Renewal Filable International Application Form

Filling out the Momentum Health Renewal Filable International Application Form online can streamline your application process, making it easier to ensure all necessary details are provided accurately. This guide will help you navigate each section of the form with clear instructions.

Follow the steps to complete your application seamlessly.

1. Click 'Get Form' button to obtain the Momentum Health Renewal Filable International Application Form and open it in your editor of choice.
2. In Section 1, enter your current membership number and the renewal start date. Specify the number of months of medical aid cover required, noting that a minimum of six months is necessary.
3. Proceed to Section 2. Fill in the principal member's details, including their passport number, country of issuance, name and campus of the institution where studying, student number, title, initials, first name, surname, date of birth, gender, marital status, and contact numbers. You may use the address of your institution in South Africa if you do not have a local address.
4. If you have a South African bank account, complete Section 3 by providing details such as the name of the account holder, bank name, account number, type of account, and branch code. Remember to avoid entering credit card details.
5. In Section 4, indicate whether you wish to keep your dependants on your medical scheme membership. If you need to change your dependant details or there was a break in membership of more than 90 days, complete the Addition of Dependants form as instructed.
6. Select your option in Section 5 regarding the chronic and day-to-day provider along with the hospital provider of your choice.
7. Fill out Section 6 with your banking details for contribution payments to Momentum Health. Use your membership number as the reference number when submitting your payments.
8. In Section 7, review the statements and confirm your understanding by providing your signature and the date at the bottom of the section. Ensure that all statements are acknowledged.
9. Once all sections are completed, review your form for any errors or missing information. Save your changes, and choose to download, print, or share the form as required.

Complete your Momentum Health renewal application online today for a smooth experience.