2025 COVER AMENDMENT FORM Please complete section A, B and the relevant section in order for your amendment form to be processed. 2020 MEDGAP COVER AMENDMENT FORM Section ASection BSection CSection DSection ESection FSection GSection HSection JSection I0% Complete1 of 10 SECTION A Type of amendment (mandatory) Principal Member Name and Surname * Principal Member ID Number Update details Complete Section B, C and I Change banking details Complete Section B, C, D and I Change medical aid details Complete Section B, C, E and I Change main member Complete Section B, C, F and I Cancel cover Complete Section B, G and I Remove dependants Complete Section B, C, H and I Add dependants Complete Section B, C, I and J (please complete a separate section J for each dependant being added) Next
