Get Gems Ex Gratia Application Form

This guide provides a clear and comprehensive overview of how to accurately complete the Gems Ex Gratia Application Form online. By following the outlined steps, users can ensure that their applications are filled out correctly and efficiently.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the application form. This will allow you to access the document in an editable format.
2. Fill out Section A, which includes the main member's details. Provide your initials, membership number, date of birth, marital status, and contact information such as your telephone number, cell phone number, email address, and postal address.
3. In Section B, detail the motivation for your application. Clearly explain the reasons for requesting Ex Gratia payment, and address any prior applications made to an employer or other insurances.
4. Complete Section C by providing a statement of total family income and expenditure. This includes disclosing your net salary, monthly household expenses, and any personal expenses.
5. Fill out Section D, which records details of installment sale commitments and credit options. Report monthly payments, outstanding balances, and the expiry dates of any relevant accounts.
6. In Section E, declare the amount you are applying for and reaffirm the truthfulness of the information provided. Sign and date the declaration.
7. Compile Section F to ensure you include all required supporting documents such as salary slips for the main member and their partner, clinical motivations, and detailed quotations for any planned services.
8. Once the application is fully completed, ensure all necessary documents are attached and submit the application to GEMS via fax, email, regional office, or postal mail.

Ensure all sections are thoroughly completed and submit your Gems Ex Gratia Application Form online today.