Looking for a 2017 GEMS MEDICAL AID QUOTE.
Application, benefits and costs.
ONLY FOR GOVERNMENT EMPLOYEES!

Please complete and send to me. Get all the GEMS Medical Aid plan options, rates and information you need.
DO YOU HAVE TO JOIN YOUR EMPLOYER'S MEDICAL AID?
YES     NO

ONLY HOSPITAL COVER?
YES     NO WANT DOCTOR, DENTIST, CHEMIST, GLASSES AS WELL

NAME

EMAIL

CITY or TOWN

TELEPHONE

How many ADULTS

Your AGE

Partner's AGE

How many CHILDREN

Your CURRENT MEDICAL AID AND PLAN?

TOTAL YEARS IN YOUR LIFE YOU HAVE BEEN A MEDICAL AID MEMBER?
AND YOUR PARTNER?

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:

I confirm that I have read and understood the notes above. Yes

Exclusions and sub - limits apply, see brochures.

gems medical aidINVESTIGATE OTHER MEDICAL AIDS!

income protectionlife insurance quotepeter pyburn brokergems quotegemspyburn@peterpyburn.co.za



Disclaimer Disclosure
2017