Membership Application

Membership

Membership Application

Please fill in the form below by clicking on ‘Get started now’ or download the application form here.

Please note that the application form must be filled in, scanned and posted -or emailed along with the additional required documents to MediCoop at applications@medi.coop.

MediCoop CFI may in terms of its constitution only transact with and provide services to its members. MediCoop CFI is owned by its members via membership shares. Democracy reigns and no single member may control MediCoop CFI. Every member has one vote regardless of the number of shares owned.

Should you wish to apply for membership, the following are the minimum requirements:

  • Only individuals or legal entities that are involved in the health care/ medical industry, such as medical professionals, health care workers and related stakeholders are eligible – being the “Common Bond” principle (more detail in the page).
  • An application form and copy of Identity Document or company registration certificate needs to be submitted (see application form link below).
  • The joining fee of R200 and minimum shares subscription of 1 000 shares of R1.00 each (R1 000) needs to be paid via EFT into the bank account as stipulated on the application form [R1 200 in total].
GET STARTED NOW
  • Personal Details


  • ID No. 1 Type

  • ID No. 2 Type

  • ID No. 3 Type

  • ID No. 4 Type

  • ID No. 5 Type

  • ID No. 6 Type

  • Gender

  • Marital Status

  • SA Resident

  • Please note that in accordance with the Constitution, each member is required to either belong to a medical professional body or be endorsed by a member of one of these bodies to use their membership number. If you are not a member of one of these bodies yourself, please ensure that the member endorsing you also signs the application form in the allocated area at the end of this application form indicating his/her authorisation of your use of his/her membership number.
  • In which language would you like to receive correspondence?
  • Race

  • This question is only for the purpose of reporting statistics to the governing body.

  • Home Address


  • Work Address


  • Postal Address


  • Please select the bodies you are a member of:


  • MEDICOOP MEMBERSHIP:


    MediCoop CFI is a cooperative bank which does business with its members. The MediCoop membership application package consist of:
    • Proof of membership with the approved organisation as listed above
    • Purchase of minimum 1000 or more MediCoop membership shares at R1000 (R1 per share)
    • Joining fee of R200
    • Accident cover of R30 000 at R30 pm
  • I hereby confirm that I have read the product features, terms and conditions.

  • Primary Account


  • Shares


    In line with the MediCoop CFI constitution a prospective member is required to purchase a minimum of 1000 shares (R1 per share) and pay a R200 joining fee in order to qualify for membership. (Please see banking details below.) Please indicate below should you wish to apply for additional shares (at R1 per share) over and above the 1 000 minimum required shares.

  • Number of additional shares required (if any):

  • Checklist (Please attach the following with your application)


  • Drop files here or
    Accepted file types: jpg, gif, png, pdf.

    Please click on the X to delete the file.

  • MediCoop CFI Banking Details


    Account name: MEDICOOP First National Bank (FNB) Branch Name: Willowbridge Branch Code: 250655 Account Number: 62534511119

    Please send proof of payment to applications@medi.coop
    Please use your RSA ID or passport number as your reference for proof of payment.
  • Contact Details


    Tel: 021 425 2288
    Email: info@medi.coop

    201, 2nd floor
    Clock Tower
    V&A Waterfront
    8001
  • GROUP ACCIDENT INSURANCE DETAILS



    Insured amount R30 000. R30 monthly premium.

    Note:
    1. The premium and cover amount increases annually on 1 January by 10%.
    2. You may join the scheme from age 15 next birthday to age 65 and remain a member until termination of membership.
    3. The application form and features (pages 6 to 8) is important. Please study them carefully.
    4. The Accident Cover is subject to final approval by JPF and / or Sanlam.
    Undertaking by insured:
    I agree that this application to join the Group Accident Cover, as well as any other relevant documents, form the basis of proposed MediCoop membership. I declare and admit that I have read the features on pages 6 to 8 and make this application by myself (self-application). I commit myself thereto and declare that it has been set out clearly and comprehensibly. I herewith consent to any underwriting profit from the Group Accident Cover and that it may be paid to JP Future Financials. Debit order for my R30 000 Group Accident Cover at R30 pm, the Cover and premium increase annually on 1 January: Debit against the following bank details:


  • I, the undersigned, request MediCoop to arrange with my bank and Multi-Data for the premiums in terms of the Group Accident Cover scheme (as amended from time to time) to be collected by debit order from my selected account. The Group Accident Cover inception date will be the first day of the next month, after successful MediCoop membership application.
  • ADDITIONAL INSURANCE POLICY OPTIONS

    (Mark the policies that interest you and a broker will contact you.)

  • Life Insurance from R30 per month, only 4 medical questions.

  • Disability Insurance from R30 per month, only 1 medical question.

  • Breast Cancer Insurance from R30 per month, only 4 medical questions.

  • MEMBERSHIP APPLICATION REWARD


    Reward for MediCoop members: Install the App Leopard.tv Wildlife Magazine FREE of charge (valued at R336 per year). On the App Leopard.tv homepage, click on the MediCoop logo/link for quick and easy access to the MediCoop website.

  • PROFESSIONAL MEMBER INFORMATION



    Please note that in accordance with the Constitution, each member is required to either belong to a medical professional body or be endorsed by a member of one of these bodies to use their membership number. If you are not a member of one of these bodies yourself, please ensure that the member endorsing you also signs the application form in the allocated area at the end of this application form indicating his/her authorisation of your use of his/her membership number.
  • This field is for validation purposes and should be left unchanged.