Application Forms

GapCover Claim Application

To access the GapCover Claim Application please click on this link.  

GapCover Application - Compulsory Group

To access the GapCover Application - Compulsory Group please click on this link.  

GapCover Application - Voluntary Group

To access the GapCover Application - Voluntary Group please click on this link.  

GapCover Application - Millennial

To access the GapCover Application – Millennial please click on this link.  

GapCover Application - Intermediary

To access the GapCover Application – Intermediary please click on this link.  

GapCover Application - Company

To access the GapCover Application – Company please click on this link.  

Declaration of Income - Existing Member

For information on Declaration of Income for existing members , please click on link.

GapCover Application - 64 years & older

To access the GapCover Application - 64 years & older please click on this link.  

GapCover Application

To access the GapCover Application please click on this link.  

NewBorn Registration

For information on Newborn registration and adding a newborn dependant please click on link.

Application for Multiply - Individual

To access the Application for Multiply – Individual please click on this link.

Application for Complementary Products - Employer

To access the Application for Complementary Products – Employer please click on this link.

Option Selection Form

For information on Option selections and option changes forms , please click on link.

Application for Complementary Products - Individual

To access the Application for Complementary Products – Individual please click on this link.

Option Selection Form - Including Declaration of Income

For information pertaining to Option Selection Form and / or Declaration of Income, please click ...

Application for Mandatory AdviseFee

To access the Application for Mandatory AdviseFee please click on this link.

Application for Conditional AdviceFee

To access the Application for Conditional AdviceFee please click on this link.

Application for HealthWaiver

To access the Application for HealthWaiver please click on this link.

Application for HealthSaver

To access the HealthSaver application please click on this link.

Chest Pain Questionnaire

To access the Chest Pain Questionnaire , please click on link.

Diabetes Questionnaire

To access the Diabetes Questionnaire , please click on link.

Examination by Pathologist or Lab

To access the Examination by Pathologist or Lab , please click on the link.

Gastro-Intestinal Questionnaire

To access the Gastro-Intestinal Questionnaire , please click on link.

Neck and Back Pain Questionnaire

To access the Neck and Back Pain Questionnaire , please click link.

Nervous Disorder Questionnaire

To access the Nervous Disorder Questionnaire , please click on link.

Request for ECG

To access the Request for ECG , please access this link.

Respiratory Questionnaire

To access the Respiratory Questionnaire , please click on link.

Special Heart Report by Specialist

To access the Special Heart Report by Specialist , please click on link .

Supplementary Questionnaire

To access Supplementary Questionnaire please click on link.

Employer Portal user application form

The Momentum Medical Scheme employer portal is designed to create an electronic platform for empl...

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