Domestic Worker Off-site


Only for existing members wanting to add their domestic worker so that they are not only covered for the paramedic service while on the property, but also receive full membership, with cards and are covered off the property anywhere in CMR’s operational area. If the household has ambulance add-on then this will apply to the domestic worker CMR member too.

Membership Number

Full Name of main member(required)

Date of Commencement

year-month-day

Payment term

I understand that the rates will increase on the 1st April 2018

Name and Surname of Domestic worker (required)

Date of Birth

year-month-day

SA ID No

Not required for children

Email (required)

Contact Number 1

Contact Number 2


Doctor's Name

Doctor's Tel

Medical Aid

Medical Aid Number


Next of Kin

not living with you

Relationship

Contact Number 1

Contact Number 2


Allergies and Medical Conditions

Please submit the form for each domestic worker.