ALLEN'S NEK

CHECK MEDICAL AID BENEFITS

Please enter the main member's details here.

First Name *

Last Name *

Phone *

Email *

ID Number *

Date of birth *

You can either upload pictures of the front and back of your medical aid card, or complete the information below. Make sure to enter the details of the person you would like us to check benefits for.

Medical Aid Card Images

Medical aid name *

Medical Aid Plan

Med aid number

Please enter the dependent's details here. Only complete this section if you are requesting benefits for a dependent on the medical aid.

Dependent First Name

Dependent Last Name

Dependent Date of Birth

Notes

Signature *

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