MediCare Account Activation

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Due to the latest PDPA regulation, SEAA is not allowed to collect NRIC from members in our membership application form. However in order to activate your MediCare account, NRIC is mandatory by MHC Asia Group. As such, the purpose of this form is to facilitate the collection of NRIC and some other basic details from you for the activation of MediCare app which you expressed keenness to sign up.

Name *

NRIC *

Contact no *

Email: *

Date of Birth *

YYYY

Declaration I *

I agree and consent to the collection, use and/or disclosure of my NRIC/FIN number by SEAA as it is necessary for the purposes of accurately establishing my identity to a high degree of fidelity in relation to "SEAA MediCare", a collaboration between SEAA and MHC Asia Group that provides subsidized medical benefits to SEAA members encapsulated in a mobile application, however with a one-time off subscription fee.

Required

Declaration II *

I am an active SEAA member

Required

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms