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Include accident insurance (basic insurance)

Are you employed by one employer for fewer than eight hours a week, are you self-employed without voluntary accident insurance, are you not in gainful employment or are you a housewife or house husband, child or pensioner? Then you must include accident cover in your basic insurance.

 

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Member ID*:
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Last Name*:
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First Name*:
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Daytime telephone:
Format 0445556677
Date of birth*:
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We will include accident insurance for you as of the first day of the month following the date this form was sent.
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