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Cash Payout Scheme Registration Form (For Direct Bank ...
Please read the Guidance Notes overleaf before completing this registration form (“Form”). Please use a non-erasable black or dark blue ball pen to fill in this Form in BLOCK letters. For any amendments, please initial next to them, and do not use correction fluid or correction tape. Bank Reference No. (For Bank Use Only)
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c.ekstatic.netNotes for completion: Y N.B. Cardio-pulmonary cases as well as those requesting continuous oxygen, stretcher or incubator should enclose a recent detailed medical report with the MEDIF (A copy of a specialist or hospital referral would generally be sufficient). Y Physicians should refer to MEDIF Part 3 for guidance with specific medical conditions.