I hereby apply for membership with SAMWU National Medical Scheme (SAMWUMED) and agree to abide and be bound by the Rules of the Scheme. I certify that the answers provided in my application are true and correct. I hereby authorise my employer to deduct, from my salary/ wages, any amount(s) owed to SAMWUMED and remit such amounts to the Scheme on my behalf. I confirm that I am ultimately responsible for ensuring that my contribution is received by the Scheme each month.
I confirm that I understand and am familiar with the benefits of the Option I have selected.
I authorise my healthcare provider or any other party who may be in possession of information concerning my or my dependant/s health to disclose such information to SAMWUMED and its business partners, provided that such information shall be kept confidential at all times. Such confidential health and personal information will only be used for purposes as outlined on this form.
I will inform the Scheme within 30 days of any changes in my or my dependant/s health or personal status as required by the Scheme Rules.
I consent to the recording of all conversations between myself and the Scheme or its contracted business partners.
Please accept declaration to proceed