Get Gap Cover Series Claim Form

Filling out the GAP Cover Series Claim Form online is a straightforward process that ensures your claim is submitted efficiently. This guide provides you with step-by-step instructions to assist you in completing the form accurately and thoroughly.

Follow the steps to complete the form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the Principle Insured Member Details section. Enter your title, surname, initials, ID number, and policy/member number. Ensure that all information is accurate to prevent any delays.
3. Provide your contact details, including your postal address, telephone number, cell number, and email address. Make sure to include the area codes where applicable.
4. Fill in the Family Doctor (GP) Details section, including the name and telephone number of your doctor.
5. Complete the Patient Details section. Enter the first names, surname, relationship to the principal member, ID number, and indicate if the patient is a dependent child over 21 years of age.
6. In the Reason for Hospitalization section, describe the reason for the patient's hospitalization, and indicate when treatment or advice was first received.
7. Provide details of hospital admissions by entering the hospital name, practice number, ward type, admission date, and discharge date. Indicate if hospitalization was a result of an accident or injury.
8. List the Providers/Doctors Details, including names, practice numbers, dates of service, and their telephone numbers.
9. In the Payment Instructions section, enter the account holder’s name, bank, account number, branch, branch code, and account type. Ensure that the account type is not a credit card account.
10. Read and complete the Declaration section by signing and dating where indicated. This confirms that the information provided is accurate and that necessary documentation will be attached.
11. Finally, review all fields for accuracy. After making any necessary corrections, save your changes, then download, print, or share the completed form as needed.

Complete your documents online today for efficient processing.