Download Application Form

Download Application

Complete the application form below.

Select your scheme, fill in all required fields, and click Download PDF. The form will be rendered to match the original printed application exactly.

Please select the medical insurance scheme you wish to apply for.

Preview

Your completed application will match this format exactly.

Membership application

Complete all sections below. Your identification document and your signature are required before the application can be submitted.

Company name, principal member, first names, surname, contact details, and more.

Foreign currency account details for claims payment.

Add family members and medical history information.

Review declarations and add your signature.

Signature area (will be rendered in the PDF).

Your completed application will be saved as a PDF file matching the original format exactly.

What happens next

Fill the form, add your signature, upload your identification documents, and submit the completed form with supporting documents to Rugare Medical.