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 (FEES INCREASE IN APRIL EACH YEAR FOR ALL MEMBERS)

    • 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. I agree to pay pro-rata for the joining month by once-off debit on the date of commencement of this membershipPlease 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 each year.

    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