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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

 Advanced Illness Benefit

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

 Application for registration of a new born baby

 Application for special payments to be made from MSA

 Application to add dependants (with underwriting)

 Applying to become a member (no underwriting))

 Applying to become a member (with underwriting)

 Chronic Illness Benefit application form

 Continuation form (application to change a main member)

 Declaration of membership

 Ex Gratia application form

 HIV PMB application form

 HIV Care Programme application form

 International claim application

 Member withdrawal application

 Permission to make certain information available to other third party

 Pre Assessment request form

 Request for additional cover for COVID-19

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

 Request for additional cover for PMB CDL conditions

 Request for extended supply of medicine

 Request for Pre-exposure Prophylaxis form

 Request to change banking details

 Reverse claims form

 Transfer from active to retiree status application


 Monkeypox outbreak

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