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Category: Application Forms

MetHealth Application Form

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©2022 – Metropolitan   |   All Rights Reserved
Metropolitan Life is part of Momentum Metropolitan Limited, a licensed life insurer and an authorized financial services (FSP44673) and registered credit provider (NCRCP173)
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Tax Paying

 You may be considered resident for tax purposes in a foreign jurisdiction if, for example: you live, work or earn money in a foreign jurisdiction; you are
a citizen or resident of a foreign jurisdiction; or other special circumstances apply to you.
You can be tax resident in more than one country at a time. Tax residency is complex and if you are uncertain you should consult your legal or tax
adviser. Metropolitan is obliged by International law to request this information which may be shared with tax authorities in foreign jurisdictions.


Tax Paying *

 You may be considered resident for tax purposes in a foreign jurisdiction if, for example: you live, work or earn money in a foreign jurisdiction; you are
a citizen or resident of a foreign jurisdiction; or other special circumstances apply to you.
You can be tax resident in more than one country at a time. Tax residency is complex and if you are uncertain you should consult your legal or tax
adviser. Metropolitan is obliged by International law to request this information which may be shared with tax authorities in foreign jurisdictions.


Member Details

Please select which option/plan you want to be registered *

Dependant's Information

Account type

Premium Banking Details

Date Of Deduction

Chronic Disease Condition

Medical History

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If yes to any of the previous questions, please state

MHL may cancel your membership immediately or propose new terms of admission if you and those that you apply for:
(a) Provide MHL with information that is inadequate, untrue, and irrelevant to this application
(b) Do not inform MHL about any relevant changes (including the change in state of health) between the date you sign this document and the date of membership commencement or acceptance by MHL
(c) Do not fully disclose the medical conditions during the time of application


2. MHL may require member’s health information from attending medical practitioner or any provider, signing of this form authorises the scheme to do so if there is any need.

3. Waiting periods may apply in certain circumstances to your membership. This means there may be a set time period before MHL start paying for any general or specific conditions.

4. It is inapropriate to be a member of more than one medical scheme at the same time.

5. Membership is open to any individual or employee of an employer and shall be compulsory in respect of employee who, in terms of his conditions of employment is required to be a member of this scheme.

6. No persons aged 65 (for corporates), 55 (Individuals) or above and no special dependant aged 55 years of age or above shall be eligible for membership of the scheme unless special approval for this has been granted by the company in its sole discretion on application by member ,employee or individual concerned and after submission of supporting medical reports.

7. An existing member may continue to be a member of the scheme with his registered dependents, if any, in the event of retiring from service of his Employer or if his employment is terminated by his employer on account of age or any reasons other than age. Members must apply to be individual members.

8. It is the responsibility of a member to ensure that contributions are paid on time every month to avoid suspension of benefits or even termination, by signing this form members authorise the employers to deduct contribution from their salaries (for corporates) and the scheme to deduct from their bank accounts (for debit order payments).

9. It is the responsibility of a member to inform the scheme of the intention to terminate his membership, one month notice shall be served and membership cards should be returned to the scheme as use of cards after termination is illegal.

10. Members must call MHL MEMBER ENQUIRY SERVICES with regards to any queries and pre-authorisation

 

I certify that the information given above is correct. I agree that should my application be accepted, I will abide by the rules, benefits and regulations set by Metropolitan Health; details of which is available on request. Signing of this contract signifies the basis of contract between Metropolitan Health and myself.