Transcription of Kindly complete the application form and submit …
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Kindly complete the application form and submit …
Administered by: Status Medical Aid Administrators (Pty) LtdReg. Number 1974/001443/07 Registered Office: Status House, 15 Tambach Road, Sunninghill Park, SandtonPrivate Bag X131, Rivonia 2128 Tel: (011) 208 1000 Fax: (011) 208 1028 E-Mail: Kindly complete the application form and submit to the Human Resources Department. NEW application NEW DEPENDANT Name of Individual Inception / Start date Name of Company OPTION A OPTION B OPTION C FOR OFFICE USE ONLY Member Number Firm Code Race (for statistical use only) Language Subs table Persal Number Code Please attach a certificate of membership from the previous Medical Aid Scheme(s) to this application TIGER BRANDS MEDICAL SCHEME Registered in terms of the Medical Schemes Act (No.)
Please complete all questions in full as non-disclosure of material information could prejudice future claims made by you and/or any of your dependants.
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