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Get Polmed Statement

At http://m.polmed.co.za or the Client Service Centre on 0860 765 633, should you require more information when completing this form. Please Note: E It is important that ALL members complete this form and return it to Polmed by 1 January 2010. E hould this form not be received by 1 January 2010, the General Practitioner that you or your dependant(s) S frequently consulted during 2009 will be nominated by the Scheme on your behalf. 1. Principal member s CONTACT DETAILS Please complete you.

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