Transcription of Addition of dependants
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Example: stock market
Addition of dependants
1 of 7ID/Passport no. nnnnnnnnnnnnn InitialSection A: Main member detailsnnnInitialsnnnnnnnnnnMembership nonnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn SurnameAddition of dependantsformNo beneficiary may be enrolled with different medical schemes simultaneouslySection B1: Details of dependantsDependant 1 First name nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnSurname nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnID/Passp ort no. nnnnnnnnnnnnnn Gender n M n FCountry in which passport was issued nnnnnnnnnnnnnnnnnnnnnnnnDate of birth nnnnnnnnD D M MY Y Y Y Mobile no. nnnnnnnnnnnEmail address nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnRelation ship with main member nnnnnnnnnnnnnnnnnnnnnnnnnnIs the dependant factually dependent on main member? n Ye s n No Has the dependant ever been a main member or dependant of GEMS? n Ye s n No If Yes, provide membership no.
divorce settlement or court. • A copy of the ex-spouse’s ID. Partner • A sworn affidavit, confirming that the dependant is the member’s life partner (the affidavit is to be completed both the main member and partner). • A copy of the partner’s ID. Child under the age of 21 (biological, adopted, step, foster child of the member or the
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