Family Subscription – ProMedical Vanuatu

What is your Citizen status?*
- Ni-Vanuatu
- Expatriate

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What is your primary location*
- Efate
- Espiritu Santo
This application is a:*
- New Application
- Renewal
- Change of details

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Primary Contact
Name*
Prefix First Last
Date of Birth*
Sex*
Medical Alerts/Allergies
Email*
Enter Email Confirm Email
Home Phone
Work Phone
Mobile Phone*

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PO Box*
Town*
Island*

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Map your Location

LatitudeLongitude
Area/Suburb*
Street*
House Description*

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Family Members*
First Name Last Name Date of Birth Sex Medical Alerts / Allergies

Please enter the details of all family members been covered

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Discount Code
Gift Code

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Subscriptions are payable in advance and are not refundable in part or in full. Cover commences upon receipt of payment and is valid for a period of twelve calendar months. “Family” subscription covers up to two adults and all dependent children (less than 18 years of age or older) living at the same place of residence. “Workplace” subscription covers nominated person during their normal working hours for the subscribed organisation, or when traveling directly to or from the organisation’s location. For emergency cases no medical authorisation is required (although services must be medically necessary). For non-emergency cases a medical practitioner must certify that paramedic care is required or that ambulance is the most appropriate means of transport. The scheme does not cover: Ambulance transport to places other than those which provide, and where the subscribed person is to receive, medical treatment (unless authorised by a registered medical practitioner). Ambulance services other than on the island of Efaté & Espiritu Santo in the Republic of Vanuatu. VEMSA reserves the right to: Prioritise services in accordance with demand, clinical need and availability of resources. Not provide services where there is uncontrolled risk to the ambulance crew. Charge full fees to subscribed persons where conditions have been breached. Suspend cover for any subscribed person who has an overdue account and has not made suitable arrangements for payment. Cancel cover for any subscribed person who abuses the scheme through misuse of services.
Do you agree to the above terms and conditions?*
- Yes, I agree
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Family Subscription Form

Primary Contact