ZA Polmed Member Record Amendment 2016 free printable template

Page 1 of 2 Deletion of Dependants Please note In the case of divorce legal documentation is required. 1. Surname of Dependant Relationship Reason Death of Member Please note An application form for continuation membership must be completed by widow/er/orphan. Date of Death Termination Date of resignation/retrenchment D D M M Y Would you like to continue your membership with POLMED YES Y Y Y NO Banking Account Details Account Holder Bank Account Number Name of Bank Branch Branch Code Type of...

How to fill out polmed dependant cancellation form

How to fill out polmed dependant cancellation form:

1. Obtain the polmed dependant cancellation form from the Polmed website or contact their customer service.
2. Fill in your personal information, including your full name, date of birth, and contact details.
3. Provide the details of the dependant you wish to cancel, such as their full name, date of birth, and relationship to you.
4. Indicate the reason for the cancellation and provide any necessary supporting documentation, such as a death certificate or proof of the dependant's coverage under another insurance plan.
5. Sign and date the form.
6. Submit the completed form to the Polmed office either in person, by mail, or electronically, depending on their specific submission guidelines.

Who needs polmed dependant cancellation form:

1. Individuals who have dependants enrolled in their Polmed health insurance plan.
2. Those who wish to remove a dependant from their coverage due to various reasons, such as the dependant's eligibility for coverage under another insurance plan or their passing away.
3. Individuals who want to update their Polmed policy by removing a dependant from their coverage.

For pdfFiller’s FAQs

What information must be reported on polmed dependant cancellation form?

The information that must be reported on a Polmed Dependent Cancellation Form includes a description of the services rendered, the date of service, the amount charged, and the medical provider's name and address. Additionally, the patient's name and policy number must be provided.

When is the deadline to file polmed dependant cancellation form in 2023?

The deadline to file a Polmed dependant cancellation form in 2023 is December 31, 2023.

What is polmed dependant cancellation form?

Polmed is a medical scheme in South Africa. The Polmed dependent cancellation form is a document used to request the cancellation of a dependent's membership or coverage under the Polmed medical scheme. This form is typically completed by the principal member (usually the primary policyholder) to terminate the coverage of a dependent, such as a spouse, child, or other family member, who no longer qualifies for coverage under the scheme. The form may require details of the dependent's information, reasons for cancellation, and the effective date of cancellation. It is important to contact Polmed directly for the accurate and latest information regarding their specific dependent cancellation forms and procedures.

Who is required to file polmed dependant cancellation form?

The person who is responsible for managing the medical aid scheme, typically the main member or policyholder, is required to file a Polmed dependant cancellation form. This form is used when removing a dependant from the medical aid scheme.

How to fill out polmed dependant cancellation form?

To fill out the Polmed dependent cancellation form, follow these steps: 1. Obtain the Polmed dependent cancellation form: You can usually download this form from the Polmed official website or request it from your employer or Polmed representative. 2. Familiarize yourself with the form: Read through the form carefully to understand the necessary information and sections to be completed. 3. Provide your personal details: Fill out your name, ID number, contact details, and any other required personal information at the top of the form. 4. Provide dependent details: Within the specified section of the form, enter the details of the dependent(s) you wish to cancel from your Polmed membership. Include their full names, ID numbers, and any other relevant information as requested. 5. Reason for cancellation: In this section, state the reason why you want to cancel the dependent(s) from your Polmed membership. It could be due to marriage, divorce, or any other applicable reason. Provide a brief explanation if necessary. 6. Signature and date: Sign and date the form at the bottom or wherever indicated. This confirms that the information provided is true and accurate to the best of your knowledge. 7. Submit the form: Once you have completed the form, submit it as instructed. This may involve handing it in to your employer, sending it by mail, or scanning and emailing it to the relevant Polmed contact. Confirm the preferred submission method with your employer or Polmed representative. Remember to keep a copy of the completed form for your records.

What is the purpose of polmed dependant cancellation form?

The purpose of the Polmed dependent cancellation form is to inform the Polmed medical scheme that a dependent of a member is no longer eligible for coverage under the scheme. This form is typically used when a dependent reaches an age limit, gets married, or any other circumstance that makes them ineligible for coverage. By submitting this form, the member requests the removal of the dependent from their policy, ensuring accurate and up-to-date information in the scheme's records.

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