Domestic Worker Off-site

Only for existing members wanting to add their domestic worker to their membership. They will receive a membership card and the membership will extend off-site, anywhere in our service area. If the household has hospital transport cover in place then this will apply to the domestic worker 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 2019

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.