Application forms

Editable application forms are now available for you to complete digitally. You can navigate through the form by pressing the down arrow. If you can't physically sign a form, you must sign it digitally. We accept digital signatures from these digital signature providers:

SigniFlow
DocuSign
Quickly Sign
Hellosign
Santamflow
Smart Advice signatures
Adobe Sign with certificate

Consent form to allow disclosure of information to a third party

Application for out-of-hospital management of a PMB condition

Application to add dependant

Advanced Illness Benefit application form

Application for registration of newborn baby

Request for additional cover for out-of-hospital Prescribed Minimum Benefit conditions

Chronic Illness Benefit application form

Continuation form

Exgratia application form

Health Declaration form

HIVCare Programme application form

Member Application - no underwriting

Member Withdrawal application form

Permission to change banking details

Pre-assessment request

Request for additional cover for PMB Chronic Disease List application form

Request for an extended supply of medicine

Request for Pre-exposure Prophylaxis

Transfer from active member to retiree status

Request for additional cover for Covid-19 testing

Request for additional cover for out of hospital Prescribed Minimum Benefit conditions

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