EMF MEDICAL AID SOCIETY
✉ emfsecretary@emfmedicalaid.com  |  +263 8677 004 128

Office Address

  • 3rd Floor Engineering Building, 88 Rezende Street, Harare (Head Office)
  • clientservices@emfmedicalaid.com
  • +263 242 780 437 | +263 8677 004 128

Membership Application

  • Home
  • Membership Application
1. Membership
2. Personal
3. Scheme
4. Dependants
5. Medical
6. Banking

Section 1: Membership Type

Please select whether you are applying as an individual or as part of a corporate group.

Section 2: Member Details

Section 3: Scheme Selection — Individual

Prices per month (USD): Member / Adult Dep / Child / Senior

Section 3: Scheme Selection — Corporate

Prices per month (USD): Member / Adult Dep / Child / Senior

Cover Start Date

The date from which your medical aid cover should commence.

Section 4: Dependant Details

Complete details for up to 4 dependants. Leave blank if not applicable.

Dependant 1

Dependant 2

Dependant 3

Dependant 4

Section 5: Previous Medical Aid

Medical History

Tick any pre-existing conditions that apply to you or your dependants.

Employment Details

Section 6: Banking Details

Required for debit order processing of monthly contributions.

Declaration

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