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Member Zone

Organisation Application / Ammendment Form

Section A: Broker or Agent details: This section must be completed by the broker or agent

Section B : Organisation details

(If Yes, Please provide us with the group number)

HR Contact Person

Finance Contact person

Section C: Banking details for refunds

Proof of banking details required in the form of letter from bank or banking details on company letterhead signed and stamped by the
relevant issuer

Section D: Company’s previous medical fund information

Section E: Your Employee Base

Section F

Biller Code: 35376                           

one money logoBiller Code: 22411                           Biller Code: 100126 

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