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Bankmed Medical Aid Scheme
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DMA user
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PIN:
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Four-digit numerical PIN of your choice:
Confirm PIN:
ID number:
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Online
Practice number:
Four-digit numerical PIN of your choice:
Confirm PIN:
Bank branch code:
Bank account number:
Name and surname of person applying for PIN:
ID number of applicant:
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Post
Please complete and print out the following
form
and post it to:
PIN Activation
Metropolitan Health Group
PO Box 4313
Cape Town
8000
Please note: Your PIN will be activated immediately. You will be notified via return of post once your PIN has been activated.
Fax
Please complete and fax the following
form
to 021 480 4087.
Please note: Your PIN will be activated immediately. You will be notified via return of post once your PIN has been activated.
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Post
Fax
First name:
Surname:
Contact number:
E-mail address:
Member number:
ID number:
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