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REVOCATION FORM FOR MEDICAL CLAIMS Authorization (MULTIPLE) I Particulars of Account Holder & Insured (as in ERIC/other identification document) Name: Date of Birth: (DD-MM-YYYY) ERIC / CPF Account
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How to fill out mohh medisave revoke form
How to fill out MOHH Medisave Revoke:
01
Start by gathering all the necessary documents and information. You will need your identification details, including your NRIC or passport number, as well as your MediSave account information.
02
Access the official MOHH website or visit one of their service centers to obtain the Medisave Revoke form. This form can also be downloaded from their website.
03
Carefully read through the instructions on the form and ensure that you understand all the requirements and conditions for revoking your MediSave account.
04
Fill out the form accurately and completely. Provide your personal details, including your name, address, contact number, and date of birth.
05
Indicate your NRIC or passport number, along with your CPF or MediSave account number.
06
Fill in the reason for revoking your MediSave account. This could be due to specific medical conditions, financial constraints, or any other valid reason.
07
Provide any supporting documents or evidence to support your reasoning for revoking your MediSave account. This may include medical certificates, financial statements, or any other relevant documents.
08
Double-check all the provided information to ensure accuracy and completeness.
09
Sign the form and date it. Make sure your signature matches the one on your identification documents.
10
Submit the completed form along with any supporting documents to the designated MOHH office or service center. You may be required to make an appointment for submission or use their online submission portal.
Who needs MOHH Medisave Revoke?
01
Individuals who are facing financial constraints and are unable to contribute to their MediSave account.
02
Individuals who have specific medical conditions where the funds in their MediSave account are no longer necessary or applicable.
03
Individuals who have alternative healthcare coverage or insurance plans that do not require contributions to their MediSave account.
It is important to note that the eligibility and conditions for MOHH Medisave Revoke may vary, and it is always advisable to check with the official MOHH website or consult with a healthcare professional for specific guidance and requirements.
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