24 HR EMERGENCIES 082 782 4444 OR 021 782 4444

24-HR EMERGENCIES

082 782 4444

021 782 4444

OFFICE
021 782 0606

EMAIL

info@cmr-med.co.za

Online Application Form

    Co-Members included

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    Monthly Membership Fees (EFFECTIVE 1 APRIL 2020)

    • Option 1: CMR Household Membership WITH Hospital Transport Cover: R395 per household per month (6 people max - see pricing below for additional people living on premises)
    • Option 2: CMR Household Membership WITHOUT Hospital Transport Cover: R280 per household per month (I understand the cost of ambulance transport to hospital will be billed separately if/when required)
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    SELECT THE OPTION THAT SUITS YOUR NEEDS
    Option 1Option 2
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    IF MORE THAN 6 PEOPLE NEED COVER AT THE PROPERTY INDICATE BELOW HOW MANY TO ADD AT AN ADDITIONAL COST OF R60.00 PER PERSON
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    Membership for Domestic workers who live off the property @ R60 p/person p/month
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    B&B Beds @ R40 p/Bed p/month
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    Start date of membership
    Immediate cover. No fee will be charged for December 2020 or January 2021 due to the CMR Summer Special. First fees will be debited in February 2021 for February onlyPlease contact me to discuss a different start date and/or a different payment method for the first month.
    Notes
    Person responsible for account
    Cheque/CurrentSavings
    Preferred debit date
    1st of month15th of month

    By submitting this form, I/we agree to subscribe to the service in accordance with CMR's Standard Terms & Conditions which are available on request and on CMR's website: www.cmr-med.co.za I/we confirm that I/we have read and understood the terms and conditions and agree to the terms thereof. All prices increase on the 1st of April 2021.

    I/we hereby authorize Cape Medical Response to debit my/our account with the total monthly premium indicated above. I/we understand that a charge of R110 will be levied for any debit-order non-payment/s.


    Please note this form will only be sent if you have ticked the "I'm not a robot" box above AND clicked on the "submit" button below.
    Should you not hear from us within 24 working hours something is not right - please call Mark on 082 851 7645 or email mark@cmr-med.co.za