Please complete the blocks below and send to me.Get a quote on all the plan options, rates and information you need. Medihelp Medical Aid.
ONLY HOSPITAL COVER?YES or NO WANT DOCTOR, DENTIST, CHEMIST, GLASSES AS WELL
HOW MANY ADULTS
HOW MANY CHILDREN
YOUR CURRENT MEDICAL AID AND PLAN
TOTAL YEARS IN YOUR LIFE YOU HAVE BEEN A MEDICAL AID MEMBER
HOW MUCH CAN YOU AFFORD EACH MONTH
ANY CHRONIC CONDITIONS
WHAT DO YOU WANT FROM A MEDICAL AID
Receive my informative letter on personal financial matters? Yes
Please note:The submission of this quote request does not constitute any legal obligation, either on your or Peter J Pyburn's behalf.It is simply a request to get some medical aid options.All information provided will be strictly confidential at all times and will be freely transmitted to the email address provided.Peter J Pyburn will not be responsible should the information be incorrectly transmitted or not reach the correct recipient.Your email address will never be given to any other person or organisation.YOU MUST CONSULT THE SCHEMES BROCHURES FOR COMPREHENSIVE BENEFIT DESCRIPTIONS AND CONSULT THE SCHEME DIRECTLY FOR ANY UNDERWRITING CONCERNS.I am an Affiliated Independent Financial Adviser and Medical Aid Broker.AT ALL TIMES, THE SCHEME RULES WILL OVERRIDE ANYTHING PETER J PYBURN HAS SAID OR WRITTEN AND AS SUCH YOUAGREE WITH THE DISCLAIMER AS PRESENTED IN THE QUOTE/S YOU HAVE ACTED UPON.
I confirm that I have read and understood the notes above.Yes
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