Loading
Get Za Polmed Application For Continuation Membership 2021-2025
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the ZA Polmed Application For Continuation Membership online
Filling out the ZA Polmed Application For Continuation Membership online is an essential step for individuals seeking to continue their healthcare coverage. This guide provides a step-by-step approach to successfully completing the application, ensuring you have all necessary information at hand for a smooth submission process.
Follow the steps to complete your application efficiently.
- Click ‘Get Form’ button to access the application form and open it in your preferred editor.
- Enter your membership number and the date in the specified format (DD MM YYYY) to authenticate your application.
- Fill in your personal details, including your surname, full first names, initials, identity number, marital status, and gender.
- Provide your residential and postal addresses along with preferred communication methods.
- Select your membership type from the options available: pensioner, medically boarded, severance package, widow/er, or orphan.
- List your dependants' details, including their names, identity numbers, relationships to you, and any income category that applies.
- Complete the banking account details accurately for refunds and contributions, ensuring to authorize the necessary transactions.
- Answer all medical history questions. Each applicant must enter their medical history and that of their dependants, marking 'yes' or 'no' as appropriate.
- If you answered 'yes' to any medical question, provide further details as instructed. Use additional pages if necessary.
- Fill out any injury claims related to road accidents or injuries on duty, if applicable, by providing required details such as accident dates and reference numbers.
- Review the POPI consent section and indicate your agreement for sharing health information electronically.
- Sign and date the form to declare that you have provided accurate and complete information before submitting your application.
- After completing the form, you can save the changes, download, print, or share your application for your records.
Complete your application online today to ensure your healthcare coverage continues seamlessly.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.