Get Application Form For A Pre-payment Certificate - Isle Of Man ...

Filling out the application form for a pre-payment certificate is essential for users in the Isle of Man who wish to save on prescription charges. This guide offers clear, step-by-step instructions to help you navigate the form online efficiently.

Follow the steps to complete your application form online.

1. Click ‘Get Form’ button to obtain the application form and open it for editing.
2. Fill in your title (Mr, Mrs, Miss, Ms, or Other) in the designated field. This identifies how you wish to be addressed.
3. Enter your surname and first name in the appropriate fields. Ensure the names are written in BLOCK CAPITALS for clarity.
4. Provide your date of birth using the format dd/mm/yyyy to verify your eligibility.
5. Input your National Health Service number. This personal identifier is crucial for processing your application.
6. Indicate your house number or name, street, town, and postcode to ensure proper address verification.
7. Enter your phone number, which is necessary for payment processing and communications.
8. Optionally, provide your email address, although this is not required for the application.
9. Specify the start date for your pre-payment certificate. Note that this can be up to 7 days earlier or one month later than the date you submit the form.
10. Select the type of certificate you wish to purchase by ticking one box only, either the 4-month certificate (£19.00) or the 12-month certificate (£54.00).
11. Choose your preferred method of payment by ticking one of the options available. Ensure not to send cash.
12. If paying by cheque or postal order, make them payable to 'IOM Government' and cross them with 'payee only'.
13. If you prefer to use a credit or debit card, provide your contact number so the finance department can call you to take your details.
14. Read and acknowledge the declaration regarding the terms and conditions associated with the application by signing and dating the document.
15. Once you have completed the form, you can save the changes, download, print, or share the application as needed.

Complete your application form online today to enjoy savings on your NHS prescription charges.