Get Health Perfect Application Form - Qa.axa-gulf.com

Filling out the Health Perfect Application Form is an essential step in obtaining your health insurance coverage. This guide provides a straightforward approach to completing the form accurately and efficiently, ensuring that you provide all necessary information.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the application form.
2. Begin with your personal details. Fill in your title, first name, middle name, last name, date of birth, P.O. Box, address, email, passport number, telephone number, mobile number, occupation, name of your employer, nationality, and the country your visa was issued in.
3. Indicate the country where you are residing for most of the year.
4. Select your desired health insurance plan from the options provided.
5. Provide information regarding any existing or previous medical insurance, including the name of the insurer, policy number, and expiry date if applicable.
6. List additional family members to be covered by specifying their names, nationalities, relationships, dates of birth, passport numbers, and where they are living.
7. Under the medical history section, report any symptoms, discomforts, or medical conditions experienced in the past two years, as well as any diagnosed conditions in the last five years for each applicant.
8. Include details of the medical practitioners frequented over the last five years, such as their names, addresses, and telephone numbers.
9. Read and complete the declaration at the end of the form, ensuring all statements provided are true and accurate. Sign and print your name along with the date.
10. Finally, attach a current passport photograph for each person covered, ensuring the names are written on the reverse, and save your changes. You may then download, print, or share the form as needed.

Complete your application online today for seamless health insurance coverage.