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FUNERAL CLAIM FORMOne form per claim Call Centre 0861 001 788 Email: info@mhasa.co.za |claims@mhasa.co.zaAuthorised Financial Services Provider FSP#1O1341. CLAIMS DOCUMENT CHECKLIST Affidavit declaring
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01
Obtain a copy of the MHA Claim Form 30-04-24.
02
Fill out your personal information, including name, address, and contact information.
03
Provide details of the mental health services received, including dates of service, provider information, and diagnosis.
04
Include any supporting documentation, such as receipts or invoices for services rendered.
05
Sign and date the form before submitting it to the appropriate party.

Who needs mha-claim-form-30-04-24?

01
Individuals who have received mental health services and are seeking reimbursement or coverage for those services.
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The mha-claim-form-30-04-24 is a document used for filing claims related to mental health assistance under specific healthcare programs.
Individuals seeking benefits for mental health services under applicable programs are required to file the mha-claim-form-30-04-24.
To fill out the mha-claim-form-30-04-24, individuals should provide personal information, details of mental health services received, and any supporting documentation required by the specific program.
The purpose of the mha-claim-form-30-04-24 is to assist individuals in claiming reimbursements for mental health services provided under eligible healthcare programs.
The form requires personal identification information, details about the mental health services rendered, dates of service, and any billing information from healthcare providers.
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