Change of dependants form

An adult dependant is anyone who is 21 years of age or older. Child rates apply to dependants between 21-24 years of age provided the student’s proof of registration from a tertiary institution is attached to the application for the current academic year.

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  Applications, Adults, Dependants, Adult dependant

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application to add dependants with underwriting

www.lahealth.co.za

application form 6LJQDWXUH RI SDUWQHU Please do not sign an incomplete application form 'DWH 'DWH 4. About your dependant/s (only complete if applying for cover) Dependant 1 7LWOH ,QLWLDOV 6XUQDPH )LUVW QDPH V DV SHU LGHQWLW\ GRFXPHQW 3UHIHUUHG QDPH 6H[ 'DWH RI ELUWK ,' RU SDVVSRUW QXPEHU &RXQWU\ RI LVVXH

  Applications, Dependants, Application to add

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