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CORPORATE INSURANCE FORM

INSURANCE MEDICAL ENROLMENT FORM FOR CORPORATE.

  • Telephone Numbers

  • Please indicate the package:

  • DEPENDANTS DETAILS

  • MEDICAL DECLARATION (for self and Dependants)

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  • SERVICE AGREEMENT

  • Case Medcare hereby agrees to provide and the Client hereby agrees to utilize the medical services of the Hospital at its above address. Case Medcare hereby warrants that it will diligently provide such services to the Client to the best of its ability using accepted scientific methods as and when required to do so by the Client. The Client hereby undertakes to pay for any additional services rendered to him which exceed the financial limits of the contractual terms. The Client hereby understands that membership fees are not redeemable 60 days after inception of cover. If termination, for whatever reason occurs within 60 days, membership fees are refundable, less the cost of treatment received by the Client during that period plus an administrative charge of 5% of the membership fee.
  • Terms and conditions apply.
 

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