Membership Card Request Form

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Membership Card Request Form

Ord. Member Number *

Ord. Member Name *

Date of Birth *

ID Number *

Beneficiary Requesting Card *

Date of Birth *

ID Number *

Dep. Number *

Cost Per Card : 2USD

*Payment can be made at Collection

Mode of Payment *

Proof of Payment

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Files must be less than 2 MB. Allowed file types: jpg, jpeg, png, pdf

Amout Paid *

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Member Email *

Cellphone *

Elite Plans

A USD based product (contributions and benefits) with little to no shortfalls

This plan is open to Individuals, SME’s (4-9 Principal Members) and Corporates (10 Principal Members and above)

Prime Plans

An RTGS product that tracks medical inflation in USD terms, contributions and benefits are adjusted regularly to maintain little to no shortfalls.

This plan is open to Individuals, SME’s (4-9 Principal Members) and Corporates (10 Principal Members and above)

Value Plans

RTGS product that maintains RTGS benefits typically following AHFoZ guidelines.

This plan is open to Individuals, SME’s (4-9 Principal Members) and Corporates (10 Principal Members and above)

Membership Card Request Form

Membership Card Request Form

Cost Per Card : 2USD

*Payment can be made at Collection

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