Get Echs Polyclinic Change Form 2020-2025

Filling out the Echs Polyclinic Change Form online is a straightforward process. This guide provides step-by-step instructions to ensure users can complete the form accurately and efficiently.

Follow the steps to complete the Echs Polyclinic Change Form

1. Click 'Get Form' button to obtain the form and access it in the online editor.
2. In the section marked 'Polyclinic File ref', enter the reference number provided for your file.
3. Fill in the 'Date' field with the current date when you are submitting the form.
4. Address the letter to the 'OIC ECHS Polyclinic' and enter the name and address of your old parent polyclinic.
5. Input your 'ECHS Card No' in the designated field to identify your card.
6. Enter the 'Name of ECHS beneficiary' as it appears on the card.
7. Specify your 'Relationship with ECHS Member' to clarify your connection.
8. Fill in the 'No' field where applicable, possibly relating to identification or record numbers.
9. Indicate your 'Rank' accurately in the corresponding field.
10. Provide the 'Name of AFV' (Authorized Family Member) as per your records.
11. Identify the 'Old Parent Polyclinic' you are transitioning from.
12. State the 'New Parent Polyclinic' you wish to transfer to.
13. Record the 'Date of change of parent Polyclinic'.
14. Fill out the 'Duration from' and 'to' fields to specify the time period for the transition.
15. As the cardholder, sign and date the declaration to certify that the information provided is true.
16. Finally, the OIC Polyclinic will need to verify and sign the form before it is considered complete.
17. Upon completion, you can save changes, download, print, or share the form as needed.

Start completing your Echs Polyclinic Change Form online today.