Scheme Forms for Members

Below are a list of Scheme forms required to make changes or additions to your membership. We include both a manual format and an easily electronic editable format. Please download the editable format to insert the signatures after which the completed form can be emailed to the relevant email address as detailed on the form. The editable electronic format is indicated as “Auto”.

Active Swopping (Change of Principal Member)
Advance Chronic Medication request
Change of Banking Details
Contribution Refund request
Dependant Termination request
Existing Beneficiary Transfer (to another membership)
Ex-Gratia Benefits application
Family Practitioner (FP) Nomination
Member Application
Member Health Declaration
Member Record Amendment – Dependant Registration
New Born Registration form
New Membership – Beneficiary Continuation
Oncology Treatment Application
Option Change request
Orthotic & Prosthetic Application
PMB Application
PMSA Refund
Savings Refund request
Termination request
Third Party Consent